Grade 2 Piles

Grade 2 piles are also known as second-degree hemorrhoids, which can cause discomforting symptoms. Grade 2 piles protrude out of the anus, especially during passing stools but retract on their own. 

If you leave grade 2 piles untreated, you will increase the risk of developing grade 3 or 4 piles which is the advanced stage of the piles and can’t be treated without surgery. 

How to Manage Grade 2 Piles Without Surgery?

Grade 2 piles usually do not require surgery. At its initial stage, it can be manageable with conservative methods, home remedies, lifestyle changes, medical intervention etc. 

Let’s begin by understanding these conservative methods to prevent grade 2 hemorrhoids from worsening. 

Over-the-counter medicines

There are various medicines available in the market to manage grade 2 piles symptoms. It can also help grade 2 piles become worse. 

  • Liquid Paraffin for Piles: Liquid paraffin is one of the best medicine to lubricate the anal passage, which makes passing stools easy. Liquid paraffin can be taken orally but consult your doctor before taking any medicine. 
  • Daflon 500 mg for piles: Daflon 500 mg is an effective medicine to manage grade 2 hemorrhoids symptoms. It contains natural ingredients which shrink piles naturally. It also helps in improving blood flow into the anorectal veins and reduces swelling. 
  • Lactulose for Piles: Lactulose is one of the best laxatives to soften stools and ease bowel movements. Before taking this laxative, consult your doctor. 
  • Lidocaine-hydrocortisone cream for piles: This is one of the best medicines to manage piles pain and itching. Lidocaine and hydrocortisone are the two main ingredients of cream to numb the anal area to prevent you from feeling pain, and hydrocortisone reduces pain, itching, and inflammation, etc. Use this medicine daily after bowel movements to alleviate pain and itching. 
  • Lignocaine 2% gel for piles: Bowel movements are excruciating if you have piles. Lignocaine gel can help eliminate pain by numbing the anal area when you pass stools. You must apply this gel to the anus 10-15 minutes before bowel movements. This is considered one of the best painkillers for piles. 

Dietary Changes

  • You should eat fiber-rich foods to soften stools and prevent constipation. Fiber rich foods include beans, broccoli, whole wheat, vegetables, fruits etc. 
  • Drink plenty of water and juices to stay hydrated throughout and ensure healthy bowel movements. Avoid caffeinated beverages and alcohol as they can dehydrate your body and complicate your piles. 
  • Avoid spicy and junk foods as they can irritate your piles and make it even more worse. 
  • Add curd or buttermilk in your diet. It can improve digestion, prevent constipation, and help reduce grade 2 piles symptoms. 

Lifestyle Modifications

  • Engage in light exercises like walking or yoga to improve digestion and promote bowel regularity.
  • Don’t strain while passing stool. Take your time and avoid sitting on the toilet for too long.
  • Don’t delay the urge to go to the bathroom. Use a squatting position while on the toilet to make passing stool easier.
  • If needed, you can take over-the-counter fiber supplements as advised by a doctor.
  • Keep the anal area clean with gentle cleaning and avoid using harsh soaps or wipes.
  • Reduce consumption of spicy and greasy foods that might irritate the piles.
  • Soaking in a warm tub for 15 minutes can help relieve discomfort.
  • Maintain a healthy weight to reduce pressure on the rectal area.

It is important to note that these conservative methods can alleviate grade 2 hemorrhoids symptoms but not a permanent solution. In some cases, surgery is also required to treat grade 2 hemorrhoids. 

When these conservative methods are not working, your doctor may recommend some non-surgical treatment approaches to treat grade 2 hemorrhoids. 

Before proceeding with any treatment, the doctor will evaluate the condition through diagnostic tests including:

  • Physical and visual examination: During consultation, the doctor will evaluate the condition visually and may ask you some questions about your symptoms, medical history, family piles history etc. 
  • Digital Rectal Exam: In this examination, the doctor will insert a lubricated gloved finger into the anus to check the abnormalities into the anus. 
  • Anoscopy: The doctor uses a small tool with a light to look inside the back passage. This helps find out how big and severe the piles are.
  • Sigmoidoscopy: Here, the doctor uses a tube with a light and camera to check the lower part of your large intestine for any issues.
  • Colonoscopy: This is a test to look inside the whole large intestine. It helps determine if bleeding is from piles or something else and guides the doctor on the best treatment.

There are various approaches to treat grade 2 piles, either surgical or non-surgical. Let’s first discuss the non-surgical options.

Non-Surgical Approaches 


Sclerotherapy is a non-surgical approach to treat grade 2 piles. It is an outpatient procedure that does not require hospitalization. It offers significant relief within a few sessions. In some cases, you may need multiple sessions for better results. 

In this procedure, the surgeon injects a chemical solution called a sclerosant into the piles which make them shrink naturally. 

Rubber band ligation (banding)

This is another non-surgical method to treat grade 2 piles. In this procedure, the surgeon inserts a small tool called a ligator into the anal canal and tie piles with a rubber band. The rubber band cuts the blood supply to the piles lumps resulting them to shrink and fall off over time. 

Infrared coagulation

This is an outpatient procedure for grade 2 hemorrhoids, in which doctors use infrared lights to clot or coagulate vessels that allow blood to flow to the hemorrhoids. The doctor uses a small probe to direct short bursts of infrared light to the hemorrhoid, which causes the enlarged piles tissue to wither and shed. This procedure is generally prescribed when the patient has bleeding or prolapsing hemorrhoids. 

These methods are effective, but there is a possibility that piles will recur. Surgical treatment is the most effective method for treating grade 2 piles when other methods do not work. Let’s discuss surgical procedures. 

Surgical Procedures

Open Hemorrhoidectomy

This is an invasive procedure in which the doctor removes the piles by making large incisions around the anus. This is a preferred option for piles that have not responded to conservative methods or lifestyle changes.

  1. You will be sedated under general anesthesia so you don’t feel any pain during the procedure.
  2. Then the doctor will make a large incision around the rectum and cut off the piles.
  3. After the piles are removed, the doctor will stitch to close the wound.
  4. Over time, the surgical site will heal and you will feel better.

It might cost between the range of INR 30,000 to INR 60,000 in India.

Stapled Hemorrhoidectomy

In this procedure, the doctor uses a special stapling instrument to push back the piles lumps inside the rectum and then cut off the blood supply so the lumps can shrink.

Here’re the steps mentioned so you understand the procedure easily.

  1. You will be administered under general anesthesia so you won’t feel any pain or discomfort during the procedure.
  2. The doctor will then use a stapling device to lift the piles back into their normal place. Then, they use the stapler to cut off the blood supply to the piles.
  3. Without blood, the piles get smaller and eventually fall off.

It might cost between the range of INR 40,000 to INR 80,000 in India.

Laser Hemorrhoidectomy

This is a procedure in which a laser or beam light is used to remove or cut off the piles. This minimally invasive procedure allows a more precise and targeted treatment to offer less pain and faster recovery than other surgical procedures.

Here are the step-by-step procedure of laser hemorrhoidectomy:

  1. The doctor will give you anesthesia so you won’t feel any pain or discomfort during the procedure.
  2. The doctor will use a laser beam to cut or remove the piles. The laser light directly hit the piles, leaving healthy tissue untouched.

What If You Leave Grade 2 Piles Untreated?

If you leave grade 2 piles untreated, it can lead to various severe complications over time. It can become extremely painful and discomforting. Grade 2 piles can turn into grade 3 and 4 piles which is the most advanced stages of piles.

In advanced stages, piles may protrude out of the anus and don’t retract on their own. It may also cause a burning sensation and itching into the anus. 

It may also lead to excessive bleeding during or while wiping after bowel movements which can cause anemia (lack of blood in body due to excessive blood loss) and make you feel tired and weak. Untreated grade 2 hemorrhoids can also lead to infection due to lack of hygiene maintainence. 

Leaving grade 2 piles untreated can lead to various serious problems which can interrupt your daily life and make you unable to do simple activities like sitting and walking. So, it is important to consult an experienced proctologist to seek proper diagnosis and treatment on time.

What Foods You Should Eat If You Have Grade 2 Piles?

Food always impact your health either positively or negatively. There are some foods you should include to your diet that can provide relief from grade 2 hemorrhoids. 

Fiber rich foods: You should add more fiber into your diet. Fiber rich foods are:

  • Whole wheat 
  • Legumes
  • Prunes 
  • Oats 
  • Coconut 
  • Apples

Olive oil: Olive oil is has inflammatory properties and it is an excellent source to relieve grade 2 hemorrhoids symptoms. You can use olive oil for cooking or directly with salads. It can soothe stools and make it easier to pass. 

Omega-3 fatty acids: Omega-3 fatty acids are helpful in reducing inflammation and itching associated with the grade 2 piles. It is found in:

  • Fatty fish (salmon, mackerel, and sardines)
  • Chia seeds
  • Flaxseeds
  • Walnuts
  • Almonds 

Whole Eggs: An egg is believed to be the best natural remedy for treating acute piles. They contain a lot of protein and are ideal for a piles-friendly diet. Eggs are a great source of nutrients without causing digestive discomfort.

Citrus Fruits: Citrus fruits have a ‘naringenin’, a natural compound that helps in softening stools and easing bowel movements. Citrus fruits includes

  • Grapes
  • Lemons
  • Oranges
  • Sweet lime 


Understanding grade 2 hemorrhoids and taking care of them is really important. We discussed how these swollen blood vessels can become painful if not treated. Luckily, there are treatments like creams and diet changes that can help.

Surgery is an option too, if things get worse. Home remedies, like eating more fiber and drinking water, also play a role.

Remember, there’s no need to feel embarrassed discussing piles. It is a common anorectal condition that affects every 1 out of 4 people. So, if you’re facing any issues, don’t hesitate to reach out to an experienced proctologist.

By looking after yourself and getting the right care, you can manage this condition and enjoy good rectal health and well-being. 


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Oftentimes, patients are so afraid of the word "surgery" that they refuse to undergo any kind of treatment, and their condition keeps worsening. However, surgical procedures for most anorectal conditions, such as piles, fissure, and fistula, are relatively simple, and thanks to advancements in medical science, they have also become increasingly less invasive. So if you are struggling with any anorectal condition, I hope this blog has helped you with relevant information that will encourage you to seek medical help as soon as possible.

I had piles for quite some time and the condition didn’t improve after trying many home remedies. When I consulted Dr. Pankaj, I was stressed after knowing that I needed surgical treatment. Fortunately, the doctor briefed me before the procedure and told me that there won’t be any cuts or stitches as they use laser technology. I trusted my doctor and had the surgery the next day. There were no cuts, stitches, or scars involved in the surgery. Now I am recuperating well and don’t feel any pain during bowel movements thanks to Dr. Pankaj

– Rohit Mehra

I had grade 2 piles which became grade 4 within a few weeks. It was very difficult for me to cope with the pain. When I consulted with my primary care provider, he referred me to Dr. Piyush Sharma Regardless of my concerns, I visited the doctor and he recommended laser surgery. At first, I was afraid, but after he explained the entire procedure, I knew that it was the best option to get rid of piles. I had my surgery a few days later which was successful. It’s been two weeks and I have recovered well after the surgery.

– Dharmesh Singh

Piles was becoming a very serious problem for me after lockdown. My physical activities were restricted and the condition became worse within a month. I came across Dr. Pankaj Sareen through Practo and booked a consultation with him. He explained the laser treatment procedure to me and described all its benefits. I had the surgery on the next day and now my condition is resolved. I am able to pass stools without any pain or discomfort thanks team

– Gaurav sinsinwar

I had heard that laser surgery was the best treatment for piles. After consulting with Dr. Rakesh Mittal, I was convinced that it is the right method for me. The doctor had more than 10 years of experience in performing laser surgery. I trusted him and had the surgery without any delay. The doctor even provided post-surgery care tips and stayed in touch with me to ensure that I recovered well.

– Vaibhav Gupta

After having laser surgery for piles myself, I would like to recommend it for people who want to get rid of piles permanently. The procedure is simple, safe, and effective. The doctor uses a laser probe that emits light energy and shrinks the swollen and inflamed tissues. The surgery took only 30 minutes and I was able to go back home on the same day. Thanks to the whole team helping me in this seamless surgical journey, I am now free from piles and can eat my favorite foods without worrying about the pain.

– Rekha Yadav

Dr. Ravi was recommended to me by my primary care physician when I told him about the symptoms. He asked me to consult a specialist immediately. So, I talked to Dr. Ravi and after diagnosis, he told me I had grade 3 internal piles. I trusted him and had the surgery a few days later. The surgery was non-invasive and there were no stitches or scars. I was able to get back to work after two days and recovered completely within a week. My overall experience of laser surgery was good and I recommend this method to anyone who needs piles treatment.

– Neeti Verma

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