Haemorrhoids (Piles)

What are haemorrhoids?

Haemorrhoids (piles) are enlarged blood vessels inside or around the opening of your bottom (anus). Your anus is lined with spongy tissue and blood vessels called the anal cushions. These help your anus to close. If the blood vessels in this area become enlarged, you might experience symptoms of piles.

How do I know if I have haemorrhoids (piles) – what do they look like?

Piles don’t always cause pain or other symptoms. But sometimes you might see blood on the toilet paper, drips in the toilet, or on the surface of your poo. You might be able to feel piles on your anus or hanging down from your anal canal too.

Are skin tags the same as piles?

No, skin tags aren't the same as piles. But you may get them if you have external piles (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 or a blood clot.

Types of piles

The following are two main types of piles.

Internal piles

Internal piles start inside your anal canal (the short, muscular tube connecting your rectum with your anus). Internal piles can also hang down and come out your anus. They’re graded into four categories:

• First degree piles: these may bleed but don’t come out of your anus.
• Second degree piles: these come out of your anus when you have a poo, but go back inside afterwards.
• Third degree piles: these come out of your anus and only go back inside if you push them back in.
• Fourth degree piles: these always hang down from your anus and you can’t push them back in. They can become very swollen and painful if the blood inside them clots.

External piles

External piles are swellings that develop further down your anal canal, closer to your anus. They can be really painful, especially if they have a blood clot in them.

It’s possible to have both internal and external piles at the same time.

Causes of piles

Piles develop when the veins in your anal canal become swollen, which may happen for a number of reasons. These include if you:

• strain when you go to the toilet, for example if you have constipation
• anal canal weakens with age
• have a persistent cough
• lift heavy objects

Piles are also common during pregnancy. They may develop due to the higher pressure in your tummy (abdomen) when you’re pregnant. They usually get better after you give birth.

Symptoms of piles

Piles don’t always cause pain or other symptoms, but if you do have piles symptoms, they might include:

• bleeding when you poo – you may see blood (usually bright red) on the toilet paper, or drips in the toilet or on the surface of your poo
• a lump in or around your anus
• a slimy discharge of mucus from your anus, which may stain your underwear
• itchy, sore skin around your anus
• a feeling of ‘fullness’ and discomfort in your anus
• a feeling that your bowels haven’t completely emptied after you’ve gone to the toilet
• pain and discomfort after you go to the toilet

These symptoms can also be caused by conditions such as:

• inflammatory bowel disease
• anal cancer
• bowel cancer
• anal fissure (tear)

If you have any of these symptoms, contact a GP for advice.

Why does the skin around my anus get itchy?

The skin around your anus often gets itchy because of a slimy discharge of mucus that can come out from your anus. This may irritate your skin and cause you some discomfort. You may also find that poo occasionally leaks out too, which can make it worse. If you have skin tags, they can trap moisture near your skin and make it difficult to clean yourself properly after you go to the toilet. This can cause further itching and discomfort.

Diagnosis of piles

Your GP will ask about your symptoms and examine you. To do this they might:

• gently put their finger into your anus to feel your rectum – they’ll wear gloves and use some gel to make it more comfortable.
• look inside your rectum using a short, tube-like instrument called a proctoscope. They may refer you to a specialist doctor to do this.

You might need to have a blood test to check if you have anaemia if you have a lot of bleeding.  

If your symptoms, examinations or 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 bowel cancer.

Self-help for piles

There’s lots you can do to improve piles symptoms. You might like to try the following:

• eat a high-fibre diet to help make your poo softer and easier to pass
• don’t have too many caffeinated drinks, like tea and coffee
• keep active each day – if external piles makes cycling difficult use a cushioned seat pad
• try not to strain when you go to the toilet
• after having a poo gently clean around your anus with water and pat the area dry

Treatment of piles

Do piles go away?

Sometimes piles can go away without treatment. Most people don’t need an operation to treat piles. But if you still have symptoms of piles and other treatments haven’t worked, or your piles keep bleeding, surgery might be the right option for you.

How do you get rid of piles?

There are plenty of piles treatments that can relieve your symptoms. Below are the main treatments for piles.

Medicines for treating piles

Below are some medicines for piles – always read the instructions, and check with a doctor if you have any concerns.

• Fibre supplements such as ispaghula husk (eg Fybogel) can soften hard poo.
• A mild laxative such as lactulose can make poo easier to pass.
• Over-the-counter painkillers, such as paracetamol, may help to ease any pain from piles. Avoid opioid-based painkillers (such as codeine). These can cause constipation.
• Haemorrhoid creams, ointments, and suppositories may ease any pain and itchiness from piles. Some contain a local anaesthetic, such as lidocaine. Only use these for a few days as they may affect the sensitivity of your skin.
• Products containing corticosteroids, such as Anusol 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. Most are available over the counter and others on prescription.

Non-surgical treatments for piles

Piles will usually go away on their own but, if they don’t, you might need a day case procedure at hospital. Non-surgical treatments include the following.

• Banding: a small elastic band is put around the pile, reducing the blood supply. The pile will die and fall off after a few days.
• Sclerotherapy: an injection of an oily solution into your piles, which will make them shrivel up.
• Infra-red coagulation: an infrared light is used to cut the blood supply to your piles and make them shrink.
• Bipolar diathermy and direct current electrotherapy treatment: In this procedure, heat or an electrical current is used to destroy the pile.

Your doctor will let you know the benefits and risks of each procedure and which is the best option for you.

Surgery for piles

Most people don’t need an operation to treat piles. But if you do, there are different types of surgery for piles, which include the following.

• Haemorrhoidectomy: pile removal surgery.
• Stapled haemorrhoidopexy: the area of tissue with piles are attached higher up your anal canal and stapled in place. Your piles then won’t come out your anus anymore and will shrink.
• Haemorrhoidal artery ligation operation (HALO): the blood supply to the piles is cut off, which makes them shrink.

Complications of piles

Piles rarely cause any serious problems but sometimes they can lead to the following.

• External piles can become inflamed and swollen; ulcers can also form on them.
• Skin tags can form when the inside of a pile shrinks back but the skin remains.
• If mucus leaks from your anus, it can make the surrounding skin very sore.
• Internal piles that hang down can sometimes get strangulated and lose their blood supply. If a blood clot forms (thrombosis), piles can be very painful. External piles can also become thrombosed.

Prevention of piles

Following a healthy lifestyle can help to prevent constipation. The following changes can help:

• Eat plenty of fibre-rich foods.
• Drink plenty of fluids – which helps to keep your poo soft.
• Limit caffeinated drinks, such as tea and coffee. And don’t drink too much alcohol.
• Exercise regularly.