Piles (haemorrhoids)

Expert reviewer, Mrs Sara Badvie, Consultant Laparoscopic, Colorectal and General Surgeon
Next review due June 2021

Piles (haemorrhoids) are enlarged blood vessels that you can get inside or around your anus. They’re usually small, round, discoloured lumps. You might be able to feel them on your anus or hanging down from your anal canal. Your anal canal is the short, muscular tube with blood vessels that connects your rectum (back passage) with your anus.

It’s completely normal to have blood vessels in your anus – they have an important role to play in continence. But piles are when they get enlarged, which can cause symptoms.

older man wearing glasses

About piles

Anyone can get piles, but they are more common as you get older. They are also more common if you often get constipated, or find you are spending long periods of time in the toilet, straining to open your bowels.

It’s difficult to know exactly how many people get piles as many people don’t go and see their doctor about them.

Piles are also common during and after pregnancy. They may develop due to changes in your hormones and the higher pressure in your tummy (abdomen) when you’re pregnant. They usually get better once your baby is born.

Types of piles

Internal piles start inside your anal canal, but they might hang down and come out your anus. They’re graded according to whether they come out, and if so, how far they come out – this is a general classification and the symptoms can vary between individuals.

  • 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 if you physically push them back in.
  • Fourth degree piles 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 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.

An image showing the different grades of piles
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Symptoms of piles

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

  • bleeding when you have a bowel movement – you may see blood (usually bright red) on 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
  • a feeling of ‘fullness’ and discomfort in your anus, or a feeling that your bowels haven’t completely emptied after going to the toilet
  • itchy or sore skin around your anus
  • pain and discomfort after you go to the toilet

These symptoms can vary a lot between individuals. They may also be caused by problems other than piles, such as inflammatory bowel disease, anal cancer, bowel cancer and an anal fissure (tear). So if you have any of these symptoms, contact your GP for advice – don’t just assume they’re being caused by piles.

Diagnosis of piles

If you go and see your GP, they’ll ask about your symptoms and examine you. They may gently put their finger into your anus to feel your rectum (they’ll wear gloves). If needed, your GP may refer you to a specialist to look inside your rectum. They’ll do this using a short, rigid tube-like instrument called a proctoscope.

You might need to have a blood test to check if you have anaemia if you have a lot of bleeding. Anaemia is when you have a low number of red blood cells in your blood. Anaemia can be a sign that you have a more serious condition.

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

Sometimes piles can be improved by making a few changes to your diet and lifestyle. There are a number of things that you can do to help.

  • Eat a high-fibre diet to help make your poo softer and easier to pass. This will help to reduce the pressure on the veins in your anus caused by straining when you have a bowel movement. Learn more about fibre and which foods to eat to up your fibre intake.
  • Drink enough fluids to keep hydrated but don’t have too much caffeinated ones like tea and coffee.
  • Try not to strain when you’re going to the toilet. Afterwards, gently clean around your anus with water and pat the area dry.

Diet changes such as increasing fibre and drinking enough fluids are known to help. Lots of people wonder if eating spicy foods makes their symptoms worse. However, there isn’t any scientific evidence to suggest this is the case, so you shouldn’t need to start cutting things out of your diet, unless your doctor advises you to.

It’s good to keep active and get your recommended amount of physical activity each day. There might be some activities that may make your symptoms more noticeable such as cycling; so, you may want to switch to something else for a while if you notice this. Generally, though, physical activity is good for your health and shouldn’t make your piles worse.

Treatment of piles

It can be uncomfortable if you have piles and it’s understandable if they make you feel a bit self-conscious. They might have an effect on other areas of your life, such as your sex life if your piles hang out or you have some discharge. But try not to worry – the symptoms usually get better within a month and the piles shrink back, although they might come back. In the meantime, there are plenty of treatments that can relieve your symptoms. If you have mild intermittent bleeding from piles, changing your diet and lifestyle to prevent constipation may be all that you need for things to get better. See our Self-help section above for more information.

Medicines for treating piles

There’s a range of medicines that 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 poo, a fibre supplement such as ispaghula husk (eg Fybogel) or mild laxative such as lactulose will soften it.
  • Over-the-counter painkillers, such as paracetamol, may help to ease any pain from piles. Don’t take painkillers that have an opioid in them (like codeine), as these could make you constipated.
  • Soothing pile creams, ointments and suppositories may ease any pain and itchiness. There are lots of different products available over the counter. Some contain a local anaesthetic such as lidocaine.
  • Products that contain 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.

It can sometimes take up to a month for self-help measures and medicines to work. If your symptoms don’t improve after this time, contact your GP. They may refer you to a specialist.

Non-surgical treatments for piles

Piles will usually go away on their own but if they don’t, you might need to have a procedure to deal with the problem. There are some treatments that you’ll need to go into hospital for as an out-patient. This means you can have the treatment and go home the same day.

  • Banding. In this procedure, your doctor will put a small elastic band around the pile, which will reduce the blood supply. This causes the pile to die and fall off after a week or two. The area left behind will heal naturally.
  • Sclerotherapy. Your doctor will inject an oily solution into your piles, which makes them shrivel up.
  • Bipolar diathermy and direct current electrotherapy treatment. In this procedure, your doctor will use an electrical current 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 still have symptoms of piles and other treatments haven’t worked, or your piles keep bleeding, it might be an appropriate option for you. There are different types of surgery for piles, which include the following.

  • Haemorrhoidectomy – this is a surgical procedure to remove piles if they’re causing problems.
  • Stapled haemorrhoidopexy – in this operation, your surgeon will attach the area of tissue with piles higher up your anal canal and staple it in place. Your piles then won’t come out your anus anymore and will shrink.
  • Haemorrhoidal artery ligation operation (known as HALO). During this procedure, arteries in your anal canal are stitched closed to limit the blood supply to your piles. Sometimes an ultrasound probe will be used to help find your arteries and guide your surgeon during the procedure. Experts aren't yet sure how well this procedure works.

Causes of piles

Piles develop when the veins in your anal canal become swollen, which may happen for a number of reasons, such as:

  • if you strain when you go to the toilet, for example if you have constipation or long-lasting diarrhoea
  • getting older – your anal canal weakens with age, which makes piles more likely
  • having a persistent cough
  • lifting heavy objects

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

Some people wonder if there’s a link between stress and piles, but there’s no evidence to suggest stress causes piles. Having piles and having symptoms, though, can be potentially stressful for some people.

Another popular question is whether you’re more likely to get piles around the time of your period. There’s currently no evidence to support this, so there’s no reason to think that you’ll get piles during your period.

Prevention of piles

Some healthy diet and lifestyle measures can help to keep your poo soft, which will help to prevent piles.

  • Eat plenty of fibre-rich foods.
  • Drink plenty of fluids but limit the caffeinated ones, such as tea and coffee.

You can get more tips in our topic: Constipation.

Complications of piles

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

  • External piles (swellings that develop further down your anal canal, closer to your anus) 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. For more information, see our FAQ: Skin tags, below.
  • If mucus leaks from your anus, it can make the surrounding skin very sore.
  • Internal piles that prolapse (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.

Frequently asked questions

  • No, skin tags aren't the same as piles, but you may get them if you have external piles. External piles are swellings that develop on the outside edge of your anus.

    More information

    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.

    Skin tags can make it difficult to clean yourself after you go to the toilet so you might feel sore and itchy. You won’t usually need any treatment for skin tags but it’s possible to have a procedure to remove them.

  • Some Chinese herbs have been suggested as treatments for piles to stop the bleeding that you can get with them. But when experts looked at all the findings from studies, they didn't find enough proof that they work. It’s also important to consider how safe these medicines are to use. Regulation of these remedies in the UK is evolving, but there’s still more to be done to ensure their safety.

  • Itching is a common symptom of piles, and it can be caused by mucus, skin tags or unclean skin.

    More information

    If you have internal piles, mucus from your rectum can leak out, which can make the surrounding area itchy. You may also find that poo occasionally leaks out too, which can make it worse.

    If you have external piles, skin tags can develop, which can be itchy because they trap moisture by your skin. Skin tags can also make it difficult to clean yourself properly after you go to the toilet, causing further itching and discomfort.

    Creams, ointments and suppositories 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.

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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, June 2018
    Expert reviewer, Mrs Sara Badvie, Consultant Laparoscopic, Colorectal and General Surgeon
    Next review due June 2021