Internal piles start inside your anal canal, but they might hang down and so come out your anus. Internal piles can be graded according to whether they come out your anus and – if so – how far they come out.
- First degree piles may bleed but don’t come out of your anus.
- Second degree piles come out of your anus when you have a bowel movement, but go back inside on their own afterwards.
- Third degree piles come out of your anus and only go back inside when you push them in.
- Fourth degree piles are always partly outside your anus and you can’t push them back in. They may become very swollen and painful if the blood inside them clots.
External piles are swellings that develop further down your anal canal, closer to your anus. They can be very painful, especially if they have a blood clot in them.
Piles don’t always cause pain or other symptoms. If you do have symptoms, they can include:
- bleeding when you have a bowel movement – you may see blood on toilet paper or drips in the toilet or on your faeces
- a lump in or around your anus
- a slimy discharge of mucus from your anus, or leaking faeces
- a feeling that your bowels haven’t emptied completely
- itchy or sore skin around your anus
- pain and discomfort after a bowel movement (if you have external piles)
These symptoms may be caused by problems other than piles, such as inflammatory bowel disease, anal cancer, bowel cancer and an anal fissure (tear). If you have any of these symptoms, contact your GP for advice.
Your GP will ask about your symptoms and examine you. He or she will feel your rectum by gently inserting a gloved finger into your anus. Your GP may also use a proctoscope to look inside your rectum. A proctoscope is a short, narrow, tube-like instrument. There are a few different types of proctoscope – some of them have their own light source whereas others don’t. You might find the procedure uncomfortable.
Your GP may also ask you to have a blood test to check if you have anaemia. This is a low number of red blood cells in your blood. Anaemia can be a sign that you have a more serious condition.
If your test results suggest your symptoms might be caused by something else, your GP may refer you to hospital for more tests. These can rule out other conditions, such as cancer.
Piles are often mild and get better with simple lifestyle changes. There are a number of things that you can do to help to relieve your symptoms.
By making diet and lifestyle changes, you can often help to relieve your symptoms. For example, eating a high-fibre diet will make your stools softer and easier to pass. This is important for reducing the pressure on the veins in your anus caused by straining when you have a bowel movement. Examples of high-fibre foods are raw fruit and vegetables, cereals and fibre supplements. Drink enough fluid to keep hydrated, and don’t have too much caffeine.
Try not to strain when you’re passing a bowel movement. Afterwards, gently clean around your anus with moist wipes or baby wipes and pat it dry. Regular warm baths two or three times a day may relieve some of your symptoms. If you have trouble getting in and out the bath, you could try a sitz bath. This is a portable water basin you can sit your hips and buttocks in. Some experts think there isn't enough proof that sitz baths help to treat piles though.
A range of medicines can help to relieve the symptoms of piles. Ask your pharmacist for advice and always read the patient information leaflet that comes with your medicine.
- If you’re passing hard faeces, a fibre supplement such as ispaghula husk (eg Fybogel) or mild laxative such as lactulose will soften your faeces. Don’t use laxatives that stimulate your bowel, such as senna, unless your doctor or pharmacist advises you to.
- Over-the-counter painkillers, such as paracetamol, may help to ease any pain you have. Don’t use painkillers that have an opioid in them (like codeine), as these could make you constipated.
- Soothing creams, ointments and suppositories may ease any pain and itchiness. There are many different products available over the counter. Some contain a local anaesthetic such as lidocaine.
- Products containing corticosteroids, such as Anugesic-HC and Proctosedyl, may reduce swelling and pain. Don’t use these for more than a week as they can damage the skin around your anus. These are generally only available on prescription.
It can sometimes take a few weeks for your symptoms to improve with self-help measures and medicines. If after this time your symptoms don’t improve with self help measures and medicines, see your GP. They may refer you to a specialist.
There are certain treatments that you’ll need to go into hospital for as an outpatient. You won’t usually have to stay overnight. These include the following.
- Banding. This involves placing a small elastic band around the pile, which cuts off the blood supply. This causes it to die and fall off after a few days. The area left behind will heal up naturally.
- Sclerotherapy. This involves having your piles injected with an oily solution, which makes them shrivel up.
- Infra-red coagulation or laser treatment. This uses infra-red light to seal the veins above the pile, which causes it to shrink.
- Bipolar diathermy and direct current electrotherapy treatment. This uses an electrical current to destroy the pile.
Most people who have one of these procedures find that it helps. You may be offered a newer procedure called Doppler-guided haemorrhoidal artery ligation. This uses an ultrasound probe to find an artery in your anal canal that can be stitched up to limit the blood supply to your piles. Experts aren't yet sure how well this procedure works.
Your doctor will let you know the benefits and risks of the procedure recommended for you.
Most piles don’t need surgery. Surgical treatments for piles are an option if you have severe piles, other treatments haven’t worked, or your piles keep bleeding. There are different types of surgery, including the ones below.
- In haemorrhoidectomy, any piles causing problems are carefully removed.
- In stapled haemorrhoidopexy, the area of tissue with piles is stitched higher up your anal canal. This means your piles won’t come out your anus anymore and will shrink.
The type of surgery that your doctor recommends for you will depend on the size and number of piles you have. Stapled haemorrhoidopexy is often recommended because people usually have less pain and faster healing than with haemorrhoidectomy.
Your doctor will explain the risks of the procedure to you, and the symptom relief you can expect.
Piles develop when the veins in your anal canal become swollen. This can happen for a number of reasons, including:
- increased pressure in your abdomen (tummy), for example when you’re pregnant or giving birth
- straining to empty your bowels, for example if you have constipation
- ageing – as you get older you may be more likely to get piles because your anal canal weakens
- diarrhoea lasting a long time
- long-term coughing
- having a family history of piles
Some factors make it more likely that piles you already have will start to cause problems. These include:
- frequently lifting heavy objects
- long periods of time sitting or travelling
- giving birth
The following lifestyle measures can help to keep your faeces soft, preventing constipation and piles.
- Eat plenty of fibre-rich foods such as fruit, vegetables, wholegrain cereal, wholegrain rice and pasta, nuts, beans and pulses. Aim to eat 25 to 30g of fibre a day. As a guide, half a cup of bran cereal contains nearly 10g of fibre and a medium-sized apple has about 3.5g.
- Drink plenty of fluids. Try to limit your intake of caffeinated drinks.
Piles rarely cause serious problems but they can lead to some complications, such as those below.
- Ulcers can form on external piles.
- Skin tags can occur when the inside of a pile shrinks back but the skin remains. For more information about skin tags, see our FAQs section.
- Mucus leaking from your anus can cause the surrounding skin to get very sore and damaged.
- Severe piles (fourth degree piles) can sometimes get strangulated, meaning they lose their blood supply. This can be very painful and cause the tissue to die.
- Thrombosed piles – this is where a blood clot forms within a pile, causing severe pain. This can be treated with a procedure to remove the clot.
You may also find that your piles make you feel self-conscious (about having sex for example). If you need any advice, speak to your GP.
Are skin tags the same as piles?
No, skin tags aren't the same as piles, but you may have them if you get piles.
Anal skin tags are common and you may develop them if you get external piles. External piles are swellings that develop on the outside edge of your anus. Blood clots can sometimes form in external piles and this will stretch your skin over the area. As the pile heals it will gradually shrink and leave behind a small tag of extra skin. You can also get skin tags without having piles.
Skin tags can make it difficult to clean yourself after you have a bowel movement. This can cause soreness and itching. Usually, you won’t need any treatment for skin tags. Taking care to clean around any skin tags after every bowel movement will reduce soreness and itching.
Are there any herbal remedies that can help piles?
There isn't enough evidence to show that Chinese medicines or homeopathic treatments can help to treat piles.
Some Chinese herbs have been suggested as treatments for piles. When experts looked at all the findings from studies, they didn't find enough proof that Chinese herbs can help to treat piles.
Flavonoids are supplements that have also been suggested to help piles, but experts disagree on whether they work. Flavonoids are naturally occurring substances found in some fruit, vegetables and other plants. At the moment, there isn't enough proof to show that flavonoids work. Experts don’t recommend them as treatment for piles.
Provided your piles aren't severe, you can probably reduce your symptoms without taking conventional medicines by eating a high-fibre diet and drinking plenty of fluid. Taking care to gently clean yourself after every bowel movement will reduce soreness and itching too.
Speak to your pharmacist if you’re thinking about using any herbal or homeopathic remedies. Natural remedies aren’t necessarily harmless or safer than conventional medicines. They’re also unlikely to have been tested as thoroughly.
Why does the skin around my anus get itchy when I have piles?
Itching is often a symptom of piles. The itching can be caused by mucus, skin tags or unclean skin.
If you have internal piles, mucus from your rectum can leak out, making it itch. If this happens, you may also find that you occasionally leak faeces, which may increase the itching.
If you have external piles, these may cause skin tags to develop. Skin tags can cause itching because they trap moisture by your skin. Skin tags can also make it difficult to clean yourself properly after you have a bowel movement, causing further itching and discomfort.
There are many different creams, ointments and suppositories that may help to ease pain and itchiness. Some contain a local anaesthetic such as lidocaine. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.
Although these treatments may give you short-term relief from your symptoms, they won’t treat or cure your piles.
- The Bladder and Bowel Foundation
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