Piles (haemorrhoids)

Published by Bupa’s Health Information Team, July 2011.

This factsheet is for people who have piles, or who would like information about them including the symptoms, causes and treatments.

Piles, also known as haemorrhoids, are swollen and inflamed blood vessels in the anal canal.

About piles

Piles are round swellings (dilated blood vessels) on the inside of your anal canal – the short, muscular tube that connects your rectum (back passage) with your anus. They develop in areas known as the anal cushions. The blood vessels may become swollen, most often as a result of straining when you have a bowel movement.

You can get piles at any age, but they are most common in people over 65. Up to three in four people get piles at some time in their life. If you’re overweight you’re more likely to get piles. Piles aren’t cancerous and you can’t catch them from someone else.

Types of piles

Although piles develop inside your anal canal, they can hang down from your anus. They are graded as follows.

• 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 stick 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 on the outside edge of your anus. They can be more painful than internal types of piles.

Symptoms of piles

Common symptoms of piles include: 

• bleeding from your anus
• a lump on 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.

Causes of piles

The exact reasons why you may develop piles aren't fully understood at present. However, it’s thought that piles may develop because of increased pressure in the blood vessels in your rectum and anus.

You’re more likely to develop piles if you:

• eat a low-fibre diet
• strain to empty your bowels (for example, if you have constipation)
• are pregnant
• often lift heavy objects
• are born with a weakness in your rectum or have a family history of piles

As you age you may also be more likely to get piles because the support structures in your rectum weaken.

Diagnosis of piles

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may examine your rectum by gently inserting a gloved finger into your anus. He or she may also use a proctoscope to look inside your rectum. A proctoscope is a narrow, tube-like telescopic camera. Air can be blown through the tube to open up your bowel so it can be seen more clearly.

Your GP may refer you to hospital to have a flexible sigmoidoscopy or colonoscopy test to examine your large bowel. This can help to rule out other conditions.

Treatment of piles

Piles are often mild and will usually get better on their own within a few days. However, there are a number of treatments that can help relieve the symptoms.

Self-help

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 will reduce the pressure on the blood vessels in your anus caused by straining when you have a bowel movement. You should also drink enough fluids to keep hydrated and don’t have too much caffeine.

Regular warm baths may relieve any irritation and help to keep your anal area clean.

If you still have symptoms after about seven to 10 days despite taking these self-help measures, consider taking a medicine or see your GP for advice.

Medicines

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.
• 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.

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 can take up to six weeks for some of these medicines to have an effect. If after this time self-help measures and medicines haven't worked, your GP may refer you to hospital for treatment.

Non-surgical treatments

These are treatments that you can have in hospital, but you won't need to stay overnight. Treatments include the following.

• Banding involves placing a small elastic band just above 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 involves having your piles injected with an oily solution, which makes them shrivel up.
• Infrared coagulation or laser treatment is where infrared light is used to seal the veins above the pile, which causes it to shrink.
• Bipolar diathermy and direct current electrotherapy treatment use an electrical current to burn the pile off.

Surgery

Surgical treatments for piles are an option if you have severe piles and other treatments haven't worked. The procedure is known as a haemorrhoidectomy and the particular type of surgery you have will depend on the size and number of piles you have.

Piles are common in pregnant women. However, surgery is rarely considered as piles usually get better after giving birth. If you're pregnant, it's important to include more fibre in your diet as this will help to soften your bowel movements. If this doesn't help, ask your GP about mild creams and ointments.

Prevention of piles

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 blood vessels in your anal area. This can help to prevent piles.

To keep your bowel movements soft try to:

• eat plenty of fibre-rich foods such as fruit, vegetables and wholegrain cereals (for example, brown rice, wholemeal bread and wholemeal pasta)
• drink plenty of fluids (about six to eight glasses a day of non-caffeinated drinks)

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.