Haemorrhoids (Piles)

Your health expert: Mrs Sara Badvie, Consultant Laparoscopic, Colorectal and General Surgeon
Content editor review by Rachael Mayfield-Blake, April 2023
Next review due April 2026

Haemorrhoids (piles) are enlarged blood vessels that you can get inside or around your anus (the opening of your bottom). It’s completely normal to have blood vessels in your anus, as they play an important role in continence. But piles can develop if these blood vessels become enlarged, which can cause symptoms.

About piles

Your anus is lined with spongy tissue supplied with blood vessels – the anal cushions – and they help your anus to close. These are perfectly normal but sometimes they can develop into piles. Piles usually look like 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.

An image showing the different grades of piles

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.

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 poo, 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.

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 or long-lasting diarrhoea
your anal canal weakens with age, which makes piles more likely
you have a persistent cough
you 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 symptoms, they might include:

bleeding when you poo – 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, which may stain your underwear
a feeling of ‘fullness’ and discomfort in your anus, or 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 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 caused by piles.

Diagnosis of piles

Your GP will ask about your symptoms and examine you. They may gently put their finger into your anus to feel your rectum – they’ll wear gloves and use some gel to make it more comfortable. If necessary, your GP may refer you to a specialist doctor to look inside your rectum, 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 or haemoglobin (the oxygen-carrying component of your blood).

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.

Hello, I am Dr Naveen Puri, I am one of the GPs within Bupa Health Clinics.

Today I want to speak to you about embarrassing problems you might have and what we can do if you attend one of our clinics.

I want you to know that many people feel embarrassed or concerned about speaking about certain things with their doctors, but I'm here to reassure you these are the kinds of things we deal with every day.

For me, looking at someone's bottom or their breasts or their genitalia is no different to looking at their nose or elbow.

And that's true for all doctors as we train for many years in these parts of the body and are very used to having these conversations with people just like you.

So what I would encourage you to do if you have any concerns from your perspective, be it a change in your bowel habit, be it a lump, a rash, a swelling. Something on your genitalia or a part of your body you're not particularly familiar with or feel uncomfortable discussing.

Please be assured your doctor has done it all before.

Some of the ways we find patients find it easier to speak to a doctor is to either tell the doctor you feel embarrassed up front. That way a doctor can make extra effort to make sure you feel comfortable.

Or some patients come to us with pieces of paper and will write the problem down and hand it to us. That way we can help with whatever is going on for you as well.

You may also find it helpful to ask for a specific doctor, someone you're familiar with in your practice. Or you might want to ask for a doctor of a specific gender, or background to your liking as well.

I'd also say, doctors do this every day so don't be alarmed if we ask you certain questions around your symptoms. It is purely so we can help you get the best outcome for your enquiry.

And then finally, feel free to use language that suits you as well. We don't expect you to know the medical words for things, or a name for your diagnosis. That's our job to find out for you.

So, take your time, see a doctor, and hopefully we can help put your mind at ease.

Hello, I am Dr Naveen Puri, I am one of the GPs within Bupa Health Clinics.

Today I want to speak to you about embarrassing problems you might have and what we can do if you attend one of our clinics.

For me, looking at someone's bottom or their breasts or their genitalia is no different to looking at their nose or elbow.

And that's true for all doctors as we train for many years in these parts of the body and are very used to having these conversations with people just like you.

Please be assured your doctor has done it all before.

Or some patients come to us with pieces of paper and will write the problem down and hand it to us. That way we can help with whatever is going on for you as well.

I'd also say, doctors do this every day so don't be alarmed if we ask you certain questions around your symptoms. It is purely so we can help you get the best outcome for your enquiry.

And then finally, feel free to use language that suits you as well. We don't expect you to know the medical words for things, or a name for your diagnosis. That's our job to find out for you.

So, take your time, see a doctor, and hopefully we can help put your mind at ease.

Need a GP appointment? Telephone or Video GP service

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To book or to make an enquiry, call us on 0343 253 8381^∧

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Self-help for piles

If you make a few changes to your diet and lifestyle it can help with the symptoms of piles. If you have mild bleeding from piles every now and then, change your diet and lifestyle to prevent constipation – this may be all you need for things to get better.

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 poo.
Drink enough fluids to keep hydrated but don’t have too much caffeinated ones like tea and coffee.
Keep active and exercise each day. There might be some activities that you may find difficult if you have external piles, such as cycling. You might find it helpful to use a cushioned seat pad if this is the case. Or, you may want to switch to something else for a while until your symptoms get better. Generally, though, physical activity is good for your health and shouldn’t make your piles worse.
Try not to strain when you go to the toilet. Afterwards, gently clean around your anus with water and pat the area dry.

Treatment of piles

There are plenty of piles treatments that can relieve your symptoms.

Medicines for treating piles

There’s a range of medicines that can help to relieve the symptoms of piles. Always read the patient information leaflet that comes with your medicine and ask your pharmacist for advice if you have any questions.

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 and add to your problems.
Soothing creams, ointments and suppositories may ease any pain and itchiness from piles. There are lots of different products available over the counter. Some contain a local anaesthetic such as lidocaine. Only use these for a few days as they may affect the sensitivity of your skin – ask your pharmacist for more information.
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. The pile will die and fall off after about a week or two and the area left behind will heal naturally.
Sclerotherapy. Your doctor will inject an oily solution into your piles, which will make them shrivel up.
Infra-red coagulation. Your doctor will apply an infrared light to certain areas of the piles, which will cut the blood supply to your piles and make them shrink.
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 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.

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: Are skin tags the same as piles? 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.

Prevention of piles

If you eat a healthy diet and lead a healthy lifestyle, it can help to keep your poo soft and prevent constipation, 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.
Exercise regularly.

Piles don’t always cause pain or other symptoms but you may know you have piles if you see blood on toilet paper or 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. These are just some of the symptoms of piles.

See our section: Symptoms of piles above for more information.

One of the main causes of piles is straining when you go to the toilet, which may happen if you have constipation or long-lasting diarrhoea. Your anal canal weakens with age, which can also make piles more likely. Other things that can lead to piles include having a persistent cough and if you lift heavy objects. They’re also common during pregnancy.

See our section: Causes of piles above for more information.

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.

See our section: Complications of piles above for more information.

Piles usually shrink and go by themselves and there are treatments that can relieve your symptoms. These include making some change to your lifestyle by eating more fibre, for example, as well as medicines to ease any pain and itchiness from piles. There are also procedures and operations to treat them if they don’t heal by themselves.

See our section: Treatment of piles above for more information.

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.

See our section: Complications of piles above for more information.

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.

See our section: Treatment of piles above for more information.

Haemorrhoids (Piles)

About piles

Types of piles

Causes of piles

Symptoms of piles

Diagnosis of piles

Need a GP appointment? Telephone or Video GP service

Self-help for piles

Treatment of piles

Medicines for treating piles

Non-surgical treatments for piles

Surgery for piles

Complications of piles

Prevention of piles

More on this topic

Did our Haemorrhoids (Piles) information help you?

Haemorrhoids (Piles)

About piles

Types of piles

Causes of piles

Symptoms of piles

Diagnosis of piles

What should I do if I'm embarrassed to talk to my doctor?

Seeing a doctor when you're embarrassed | Watch in 2:08 minutes

Need a GP appointment? Telephone or Video GP service

Self-help for piles

Treatment of piles

Medicines for treating piles

Non-surgical treatments for piles

Surgery for piles

Complications of piles

Prevention of piles

More on this topic

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