PILES#HEMORRHOIDS#RECTAL BLEEDING#CONSTIPATION# ANAL FISSURE # RECTAL PAIN#RECTAL DISCHARGE#RECTAL MASS#RECTAL CANCER Anorectal diseases are one of the most common cause of visiting a surgical clinic.To common men all anorectal problem appears to be either piles or fistula. Everyone seem to know about these diseases better than any physician at any point of time.Treatment to many is easy. Thanx to the ever growing list of over the counter drugs,( the most common being Isobgul) that common men and women can get without a prescription.This is compounded by a tendency among patients to self treat themselves and take their health in their own hands.As a consequence, what begins with a minor symptom of constipation soon turns into a hard problem to treat. Visiting multiple doctors ,taking medications without any sceintific evidence and frequent change of physician along with irregular use of medicines is common to 90% of these patients.As a result most of these patients often suffer from low esteem,uncertainity and fear of having something more ominious than what they actually have.A major share of my patients comes up with long history of having undergone multiple ineffective treatment without cure. The reasons for this is many The root cause of all most all anorectal diseases starts with life style. Irregular bowel habit,a stressful life, lack of sleep,too much consumption of junk food or over consumption of red meat, with reduced dietary intake of water,fruits and vegetable are some of the important risk factors for anorectal diseases.Tackling the symptoms without an effort to introduce life style changes is bound to fail.As such many patients are bound to have recurrent symptoms inspite of initial cure. Secondly not all anorectal bleeding or pain while defecation is due to piles or related to piles.Each patients symptoms merit individual assessment and even those with overtly similar presentations might have diseases poles apart. Piles,fissure,fistula, ulcer, anal tags are different diseases with different causes and hence have separate treatment protocol.Identification of each one of them needs trained mind and experienced hands.Each patients need Digital Anorectal examination and a formal proctoscopic examination for complete assessment of his/her disease status.These are painless outdoor procedures which help us diagnose anorectal conditions with cent percent confidence. Clumping all anorectal diseases and treating them similarly is not only unwise but can be extremely harmful too.I have seen many patients being treated as piles for years,later only to be diagnosed with rectal cancer. Thirdly we in India are least well informed. and least interested in taking scientific medication and proven methods of treatment.Every 3 patients out of 5 believe and do more what their peers or influencers say,rather than seeking the right medical advice at the right time. The 4th factor for many of us is the shame and guilt associated with this ano rectal symptoms which stops us from expressing it at the right time.This is also a common factor for late presentation. The 5th and perhaps the most common factor contributing to such chronicity of anorectal maladies is the unbiased fear with surgery. No doubt 90% of us hate surgery or do not want to be operated due to either fear of pain or delayed recovery.This prevents many from seeking the right treatment at the time when it would have been most successful. Last but not the least a part of the anorectal diseases might be attributable to ones genetic make up which makes some individual more sucesptible than others to Anorectal problems. Well some general steps that everyone can follow to keep PILES at bay are as under: !.Never take laxatives without medical advice.They are habit forming and have very adverse long term impact on one's bowel patterns 2.Learn to defecate on time,say a particular time of the day..example going to stool after you wake up in the morning. 3.Donot postpone your bowels.Make a habit to go to loo daily and on time.This helps one to build a smooth regular bowel habit. 4.Drink plenty of water daily( 2 to 4 litres a day unless you have absolute contraindications like kidney or heart disease.This keeps you hydrated and softens your stool also 5.Donot read books,listen to music,or toggle your phone while you are defecating.This is a negative habit and takes your concentration away from passing your stool. In case of recent change of symptoms maintain a symptom diary which will help your doctor understand your disease pateern better. 6.Avoid excessive redmeat consumption. 7.Include green vegetables,legumes,fruits and leaves in your daily diet.This give you all the nutrients needed to rejuvenate your colon. 8.Avoid alcohol and smoke 9 .Regularise your sleep and give yourself adequate rest.This allows your body to redirect energy to more important processes of your daily life. 10.Early morning jogging and exercise is helpful in maintaining your overall physique and gives you a sense of well being even in face of disease. 11. De stress yourself.Yoga and meditations can be helpful. 12.Most importantly do not be careless about your health..In case of symptoms you should always seek medical advice instead of searching it in google or asking your peers who are often ill informed or half informed. 13.In case of persistent symptoms, stool softners are also helpful to improve your symptoms. 14.Most piles are painless and are often associated with fresh blood with stool.This differentiates them from fissure which is often very painful 15.Treatment usually consists of Sitz bath and supportive medications 15.A correct diagnosis is important if you are expecting cure. 16.In case of persisting symptoms a colonosopy or sigmoidoscopy is warranted. 17,99% cases of piles can be cured with surgery.It is done painlessly under locoregional anaesthesia and proven to be safe and effective too.