Internal piles develop inside your anal canal, but they can hang down outside your anus. Internal piles can be graded according to how far they protrude, if at all, from your anus.
- First degree piles are swellings on the inside lining of your anal canal. They may bleed but can't be seen from outside your anus.
- Second degree piles are larger than first degree piles. They come out of your anus when you have a bowel movement, but go back inside on their own afterwards.
- Third degree piles hang down from your anus and only go back inside when you push them in.
- Fourth degree piles permanently hang down from 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 more painful than internal types of piles.
Common symptoms of piles include:
- bleeding from your anus – you may only see this as bright, red blood on toilet paper
- a lump in or around your anus
- a slimy discharge of mucus
- a feeling that your bowels haven't emptied completely
- itchy skin around your anus
- swelling 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. If you have any of these symptoms, see your GP for advice.
Your GP will ask about your symptoms and examine you. He or she is likely to examine 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 with a light source. Air can be blown through the tube to open up your bowel so it can be seen more clearly. This test should not be painful but it may be uncomfortable and make you feel as though you want to have a bowel movement.
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 the symptoms.
Diet and lifestyle changes 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 increased pressure on the veins in your anus caused by straining when you have a bowel movement. Drink enough fluids to keep hydrated and don’t have too much caffeine.
Try not to strain when you’re passing a bowel movement and gently clean around your anus with baby wipes afterwards. Regular warm baths may relieve any irritation and help to keep your anal area clean. See our frequently asked questions for more information.
If you still have symptoms after about seven to 10 days despite using self-help measures, you may wish to consider taking a medicine or seeing your GP for advice.
There are a range of medicines that can help relieve the symptoms of piles.
- If you're passing hard or infrequent faeces, a fibre supplement such as ispaghula husk (eg Fybogel) or mild laxatives such as lactulose, will soften your faeces. Don't use laxatives that stimulate your bowel, such as senna, unless your GP advises you to.
- Over-the-counter painkillers, such as paracetamol or ibuprofen, may help to ease any pain you have.
- 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 inflammation 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.
Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your GP or pharmacist for advice. See our frequently asked questions for more information.
It’s important to be aware that it can take several weeks for some of these medicines to have an effect. If after this time your symptoms haven’t improved and are troublesome, or your haemorrhoids are severe, your GP may refer you to see a specialist for treatment.
There are certain treatments that you will need to go into hospital for, but you won't 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 and 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 burn off the pile.
Surgical treatments for piles are an option if you have severe piles and other treatments haven't worked. There are different types of surgery, including haemorrhoidectomy or stapled haemorrhoidopexy. The type that is recommended for you will depend on the size and number of piles you have.
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, for example as a result of pregnancy
- 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 the support structures in your rectum weaken
- not eating enough fibre
- frequently lifting heavy objects
- having a weakness in your rectum
- having a family history of piles
It isn’t true that you can get piles by sitting on cold, hard surfaces.
If you have daily bowel movements that are solid but soft and you don't need to strain, faeces will pass easily and won't put pressure on the veins in your anal area. This can help to prevent piles.
The following lifestyle measures can help to keep your bowel movements soft and prevent constipation, and therefore piles.
- Eat plenty of fibre-rich foods such as fruit, vegetables, bran and wholegrain cereals (for example, brown rice, wholemeal bread and wholemeal pasta). Aim to eat 25 to 30g of fibre a day – as a guide, a slice of wholemeal bread contains 2 to 3g and a medium-sized apple has about 3.5g.
- Drink plenty of fluids (about six to eight glasses a day of non-caffeinated, non-alcoholic drinks).
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 folds of skin that develop in your anal area, sometimes as a result of an underlying condition.
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 an external pile heals it will gradually shrink and leave behind a small skin tag made up of the excess skin.
You can get skin tags without having piles, and they are sometimes associated with other anal conditions, such as inflammatory bowel disease or an anal fissure (a small tear in the skin lining your anus). You may develop a type of skin tag called a sentinel tag if you have an anal fissure.
Skin tags can make it difficult to clean yourself after you have a bowel movement, which can lead to itching, discomfort and sometimes infection. Usually you won’t need any treatment for skin tags, but if they are causing severe problems or discomfort, you may be able to have an operation to remove them.
Are there any natural or herbal remedies that can help piles?
A number of natural and herbal remedies have been suggested as treatments for piles, including traditional Chinese or Indian medicine and homeopathic treatments. However, in general there isn't enough evidence to show that they are effective. The best way to reduce your symptoms without taking conventional medicines is to eat a healthy diet with plenty of fibre, drink enough water and take care to clean yourself after every bowel movement.
You may have heard of sitz baths being recommended for piles. A sitz bath is when you sit in a bath or basin filled with warm water so that only your hips and buttocks are covered. It's thought that the warm water may encourage blood flow to the area and relax the sphincter muscle (which controls the opening and closing of your anus). This may help to relieve pain and itching. Sitz baths may also be helpful in keeping your anal area clean.
However, although sitz baths are often recommended, there is little evidence to show that they are effective. There is uncertainty over whether you should use warm or cold water and how long you should sit in it for.
Other remedies that have been suggested for piles include flavonoid supplements. Flavonoids are plant pigments found in some foods, including apples and onions. It's thought that flavonoids have an anti-inflammatory effect but there is little evidence to show that they work and they aren't licensed for use in the UK.
You may also have heard the herbal extract euphorbia prostrata suggested as a treatment for piles. Again, there is very little evidence to support its use and it’s not recommended for piles.
Speak to your GP if you’re thinking about using any herbal or homeopathic remedies. It’s important to remember that natural remedies aren’t necessarily harmless or safer than conventional medicines. They also won’t have been tested as thoroughly.
What treatments for piles can I get from a pharmacy?
There is a range of different creams, ointments and suppositories for piles that you can buy over the counter from your pharmacy. However, it's important to remember that these treatments will only relieve your symptoms and they won't cure piles.
The aim of creams, ointments and suppositories is to soothe and relieve your symptoms. They all contain different ingredients, which work in different ways to reduce pain, swelling and itching.
It’s important not to use medicines that contain an anaesthetic, such as lidocaine, for longer than a few days as your skin can become sensitive to them. Don’t use medicines that contain corticosteroids for more than a week. If you use them for longer than this, they may damage your skin. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
If you’re pregnant, ask your GP or midwife for advice about what medicines are safe for you to use.
Painkillers, such as paracetamol, may help to relieve any pain from piles. However, don't take painkillers that contain opioids, such as codeine, as they can cause constipation. Also, non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aren't suitable if you’re bleeding from your rectum.
If your symptoms continue to get worse despite using medicines, or if you have any questions or concerns, see your GP.
Why does the skin around my anus get itchy when I have piles?
Itching is often a symptom of piles. It can happen if your piles are internal or external, but each type has a different underlying cause.
Your rectum is lined with a thin film called the rectal mucosa. It produces mucus to keep the area lubricated and to help faeces pass through your anus. Internal piles can cause the rectal mucosa to slip down out of place. The mucus then passes onto the skin around your anus causing it to become irritated and itchy. If this happens, you may also experience soiling, which may increase the itching.
If you have external piles, the itching may be caused by skin tags, which can develop as a result of piles. These can hold moisture around the skin of your anus, which irritates the area. Skin tags can also make it difficult to clean yourself properly after you have had a bowel movement, which can lead to further itching and discomfort.
There are many different creams, ointments and suppositories that may help to ease any pain and itchiness. Some contain a local anaesthetic such as lidocaine. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your GP or pharmacist for advice.
It's important to remember that although these treatments may give you short-term relief from your symptoms, they won’t treat or cure your piles.
Will having piles affect my sex life?
It’s possible that piles may affect your sex life as they can make it painful or difficult, particularly if they are severe. They may also make you feel self-conscious. However, there is no medical reason why you can’t have sex if you have piles.
Piles can affect your sex life both emotionally and physically. It depends on how severe your piles are as to how much they will affect you.
If your piles are quite minor, they are very unlikely to interfere with sex. However, if you have more severe piles, especially if they hang down from your anus and you can't push them back inside, they may make you feel self-conscious and not want to have sex. If the piles become very swollen and painful, you may feel too much pain to have sex, particularly if you have anal sex, and this may be a good reason to get them treated.
If you have surgery to remove piles, it’s important to wait until the area has healed before you have sex. If you have any questions or concerns about having sex after an operation to remove piles, ask your GP or surgeon for advice.
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- Bowel Cancer Screening. The colonoscopy investigation. NHS Cancer Screening Programmes. www.cancerscreening.nhs.uk, published May 2006
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- Personal communication, Dr Adrian Raby, GP and Clinical Lecturer in Medical Ethics and Law, Imperial College London, 3 June 2013
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