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Proctology is a field in medicine dealing with diseases and disorders of the rectum, anus, colon and pelvic floor.

What types of problems can be covered under Proctology?

Varicosities or swelling, and inflammation of veins in the rectum and anus (hemorrhoids)

  • Unnatural cracks or tears in the anus (anal fissures)
  • Abnormal connections or passageways between the rectum or other anorectal area to the skin surface (Fistulas)
  • Severe constipation conditions
  • Fecal incontinence
  • Protrusion of the walls of the rectum through the anus (rectal prolapse)
  • Birth defects such as the imperforate anus
  • Cancer of the colon and rectum (colorectal cancer)
  • Anal cancer (rare)

Any injuries to the anus

Proctology is a rare speciality found in India and across other countries. There are hardly any Proctologists in India practicing anorectal problems as their core speciality. Dr. Ashwin Porwal is one such leading Proctosurgeon from Pune, India. He is the only Proctosurgeon who is doing maximum work on anorectal diseases and STARR & Stapler Haemorrhoidopexies in Asia. With the inauguration of his own Healing Hands Clinic (Centre for Piles, Constipation and Hernia), Dr Ashwin Porwal is also the head of the Proctology Department of Pune’s leading hospitals like Apollo Jehangir Hospital , Poona Hospital & Reasearch Centre, Ruby Hall Clinic and Inamdar Hospital, Fatimanagar.

With a huge number of patients falling prey to anorectal problems, they face numerous difficulties in day to day life. We have a huge class of people from United States of America, United Kingdom, Iran, Iraq and Saudi Arabia who are victims of Hemorrhoids. These patients suffer silently and are conservative to discuss their problems and are very confused. We get a huge class of patients who come for Second opinion. Many of these are the victims of undergoing wrong treatments.

Dr. Ashwin Porwal graduated from B.J. Medical College, Pune and completed DNB in General Surgery from Poona Hospital and Research Center. He has undergone certified training in Advanced Laparoscopy, Bariatric Surgery from Genoa Medical School, Italy and Wound Management from Madeleine Flangan University of Hertfordshire, U.K.
Dr. Porwal also holds a Diploma in Laparoscopic Surgery from EITS – IRCAD, Strasbourg University, France. He had the privilege of obtaining training in Proctology from renowned surgeon Dr. Longo at St. Elizabeth Hospital, Austria.


  • The first STARR (Stapled Transanal Rectal Resection) surgery in Maharashtra in 2009.
  • He has performed maximum STARR procedures and Stapler Haemorrhoidopexies in India.
  • Author for publishing paper on “Efficacy and Tolerability of Intramuscular Dexketoprofen in Postoperative Pain Management following Hernia Repair
  • Surgery”(
  • Selected among International speakers in World Congress on Coloproctology in Rome, 2011
  • Presented a paper on Haemorrhoides Surgery and STARR Surgery for constipation in World Congress Meet for Coloproctology in Rome, 2011(

STAPLER HAEMORRHOIDOPEXY :Piles (clinically known as hemorrhoids) basically, is the swelling of blood vessels near the anal opening and a sliding down of the lining of the anal canal. Piles are lumps that from inside the back passage and on the surface of the anus. The lumps are formed by increased pressure on blood vessels in the area, causing them to enlarge and swell. We understand that piles may not be a subject you feel comfortable talking about, but there is no need to suffer in silence. If you have got piles, you are not alone. Piles will affect one in two of us.
As the disease advances, a systematic clinical examination and diagnosis from a Proctologist is of utmost importance. Treatment options includes:

  • Medical: Grade I and early stage of Grade II can be treated with the help of medicines and dietary modification.
  • Surgical: One of the most advance Minimally Invasive Procedure for hemorrhoids (MIPH) is STAPLER Surgery.

After years of surgical research, the 21st century saw the invention of Stapler Surgery (Minimally Invasive Procedure for Haemorrhoids). Stapler surgery is one of the best option treatment of piles as it is associated with minimal pain and faster recovery (can join on duty from 3rd day)

It is minimally invasive procedure that reduces the prolapsed of haemorrhoidal tissue. A unique stapling technique is used to push the swollen blood vessels back into their normal position. It is a day care procedure.

1) Preparation: Requires nil mouth for about 6 hrs prior to the surgery.
2) Surgery: It takes only 15 to 45 minutes. It is usually done under spinal anaethesia. It is done through natural opening, with the help of use and throw transparent device known as Stapler. In this surgery there is no any cut outside and no stitches so there is no need of dressing after surgery.
3) Post operative after care: Patient can have his full diet 4 hrs after operation. Patient can walk around, after 5 -6 hrs Patient can be discharged within 24 hrsOn discharge antibiotics and painkiller for 3 to 5 days are advised.

For this surgery a hospital stay of 24 hours is required where the patient is immediately discharged within 24 hours. He can also rejoin work from the 3rd day depending on his recovery time. But there are a few points that need to be considered and followed after getting discharged for complete relief from the problem of piles. They are as follows:

  • Have plenty of fluids, a fibre rich diet i.e green leafy vegetables fruits etc and eat less spicy and oily food.
  • Do not sit for long hours on the toilet unless the need for defecation.
  • Do not strain while defecation.
  • Defecate only when the need arises and don’t make it a routine habit.
  • Avoid sitting for long hours in one place like work stationi.e for more than 45 minutes. Give mobility to your body.
  • Avoid excessive driving and exercise in the first month. The patient can start with mild exercises like walking after one week and get back to the normal routine after 2-3 weeks
  • depending on the recovery time and under the doctor’s advice.

After operation sometimes there might be slight discomfort and mild pain in the anal region accompanied by little bleeding too. But this symptom is common in some post operative patients for the first 1-2 weeks. Routine follow up of the doctor is a must.

STARR (Stapled Trans Anal Rectal Resection)

Constipation is one of those topics few people like to discuss. But if you suffer from constipation you know it can be painful and frustrating and interferes greatly with your daily life. Almost everyone suffers from constipation at some time. Studies show that up to 16 percent of women in the India meet symptom criteria for chronic constipation. Moreover, people tend to suffer with the condition for a long time. Research shows up to 45 percent of individuals with constipation report having the condition for five years or more. Now there is a good reason to talk about chronic constipation. There is a surgical alternative that may be able to help women who have been unable to find solutions in the past for a type of chronic constipation called Obstructed Defecation Syndrome (ODS). Before you can understand whether you may have ODS, you need to understand more about chronic constipation.

ODS is a form of chronic constipation that affects thousands of people in the India – primarily women. In many cases, it is part of a more generalized weakness of pelvic support structures. Women with ODS commonly plan their daily activities around their bowel habits.

If you have chronic constipation and also have one or more of the following symptoms at least 25 percent of the time during bowel movements, you may have ODS:

  • Multiple trips to the bathroom.
  • Prolonged straining.
  • Incomplete elimination, and/or prolonged time to have a bowel movement.
  • Routine use of laxatives or enemas.
  • The need to press around your genitals or anus to have a bowel movement.

Most of the time, chronic constipation can be relieved using a combination of diet, exercise and medication. If these approaches do not relieve your chronic constipation, you should discuss treatment options with a physician. You may be suffering from a type of chronic constipation known as Obstructed Defecation Syndrome (ODS).

STARR is a surgical procedure that is performed through the anus, requires no external incisions and leaves no visible scars. Using a surgical stapler, the procedure removes excess tissue in the rectum and reduces the deformities that can cause ODS. Patients undergoing STARR are typically hospitalized for one to three days and have minimal recovery time after leaving the hospital.

Is STARR Effective?
Yes. In a recent clinical study, chronic constipation symptoms significantly improved in most patients undergoing the STARR procedure. Overall patient satisfaction with the STARR procedure was high, with 90 percent of patients rating the results as either good or excellent.

The patient needs to take utmost care after going home regarding his lifestyle patterns. As this condition is a result of chronic constipation the patient needs to modify diet patterns and include a high fibre diet as well as increase the water intake as much as 3-4 litres. Post surgery the patient can go home within 24 hours. He can also join work from the 3rd day depending how fast is the recovery. But there are some points that need to be kept in mind to get 100% relief from the surgery.

Do not sit for long hours in one place i.e not more than 45 minutes. Give maximum motility to your body.
When you feel the urge of defecation, do so, as avoiding the urge can pose problems again for constipation.
Do not forcefully defecate, but do so when you get the urge.
Include a lot of fibre rich food like green leafy vegetables, fruits etc.

Usually post surgery some patients might have mild pain in the anal region, little discomfort whileb sitting, burning sensation in the anal region or even little bleeding with the stools sometimes. But this is a common problem that might occur within the first 1 to 2 weeks. The patient must also keep in mind to clean the back passage with warm water especially after defecation. After a week or so the patient can start mild exercises so that he gets back to his normal routine as early as possible. But the patient must keep in mind not to give too much stress on the body.


Apoorv Rajore
18 Years, Student (Pune)
I had severe pain in stomach followed by nausea and vomiting. I took medicines for the time being but faced the same problem again within a few days. I was very tensed as my final exams were just 2 weeks ahead. I consulted Dr. Ghiya to which he referred me to Dr. Ashwin Porwal who diagnosed my problem as acute appendicitis. I expressed my concern for the operation that he suggested me at the earliest. But as Dr. Porwal explained me the depth and severity of the problem I knew it had to be solved at the earliest. I got operated the same day. Dr. Porwal explained me and my parents about the surgery to which I was a bit relaxed as I came to know I would be discharged in 48 hours. One more concern I had was being at a young age I am used to wearing low waist jeans and the stitches would then show up post surgery. Dr. Porwal suggested me a silicon strip for the same for which I am very thankful. Even today, remembering those days I would like to express my gratitude to Dr. Porwal and the faculty of InamdarMultispeciality Hospital for the utmost care taken during the hospital stay. Today I live a satisfied and pain free life !!!

Mr Amit Padhye
40 years, Businessman (Pune)
Sitting for long hours in one place for my job was a routine. I stopped exercising due to my hectic work schedule due to which I started gaining weight gradually. After a period of time due to my irratic schedule I started having a lot of constipation problem which I didn’t pay heed to. But later on I started suffering a lot from constipation with bleeding many times. I read about Dr. Porwal on the internet, for which I consulted him at the earliest. I was advised for Stapler Surgery. My condition worsened due to which I wanted to get operated at the earliest. I was relieved to hear that there would be no cuts so therefore no dressings later. Post surgery follow up of Dr Porwal and the entire team was excellent till date and my health is as better as can be. The diet consultation done has given me a lot of relief. All thanks to Healing Hands Clinic Team!!

Mr. Abdulla Nasser
50 Years, Electrical Engineer (Iraq)
I am from Iraq & had come to visit a relative in India . Due to change in climate and location I had a problem adapting to the food habits and lifestyle. I started facing constipation problem with pain & bleeding for which I came to Inamdar Multispeciality Hospital. They referred me to Dr. Ashwin Porwal. One sitting with Dr. Porwal, I was briefed with my Grade 2 piles problem with fistula that I was facing since the last 6 months. He suggested me to get operated. But I was flying back to Iraq after a week where I would be joining work again. I got admitted the next day itself after he told me there would be no cuts so would be no need to come for dressings every time. I had a wonderful experience during my stay as his entire team took care of me through out my stay. I was also counseled for my diet and lifestyle modification before my discharge by Dr. Porwal's assistant. Today you can say I have completely been washed off the pain that I was going through. But this entire credit goes to Dr. Ashwin Porwal, his team and Inamdar Multispeciality Hospital due to which I lead this happy life. Thank You !
Popat Date
52 Years, Assistant PF Comissioner (Pune)
I was suffering from fistula in ano since last 2 years. Because of fistula I had severe pain while sitting and defecation, severe itching sensation and pus discharge. I was feeling very uncomfortable because of these symptoms. I didn’t have the courage to discuss these problems with my family members. I am an Assistant P F Commissioner in Gujrat. When my symptoms worsened it was impossible for me to continue my work. I am basically from Pune and my family stays in Pune. Getting his reference from The Times of India immediately consulted Dr. Ashwin Porwal for my problem at Inamdar Hospital. He diagnosed me as fistula in ano with grade II hemorrhoids and advised fistulectomy stat and Stapler hemorrhoidectomy after 3 months. After Dr. Ashwin Porwal’s consultation I felt relaxed and got confidence about permanent cure with minimum pain. But I couldn’t stay in Pune as I had emergency meetings at Gujrat the very next day so Dr Ashwin Porwal gave me medication for temporary relief and scheduled the surgery date after 15 days. His team took utmost care of me all the time on phone in between that period. They did all the formalities of insurance for hospitalization in my absence. Dr Porwal conducted the surgery very well. After surgery also he and his team called me for a constant followup till today. Diet consultation helps me a lot. I am heartily thankful to Dr. Ashwin Porwal. He looks for patient happiness from time to time.