Haemorrhoids (Piles)

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.

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, such as:

• if you strain when you go to the toilet, for example if you have constipation or have had diarrhoea for a long time
• as you get older because your anal canal weakens with age, which makes piles more likely
• if you have a persistent cough
• if 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.

Some people believe there’s a link between stress and piles but there’s no evidence to support this. But having piles can be potentially stressful.

Another theory is that you’re more likely to get piles around the time of your period. But there’s currently no evidence to support this.

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
• 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 doctor for advice – don’t just assume they’re caused by piles.

Diagnosis of piles

Your doctor 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 doctor  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 doctor may refer you to hospital for more tests. These can rule out other conditions, such as bowel cancer. 

Self-help for piles

If you make a few changes to your diet and lifestyle it can help with the symptoms of piles.

• 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.

You won’t need to cut things out of your diet unless your doctor advises you to.

Treatment for piles

If you have piles, it can be uncomfortable, 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 – piles usually last less than a month and then shrink back, although they might come back.

In the meantime, there are plenty of treatments that can relieve your symptoms. 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. 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. 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 doctor. 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.