What piles are
Everyone has cushions of blood vessels inside the lower rectum and anus that help control stools. When these cushions swell and stretch, they are called piles or haemorrhoids. Internal piles lie inside the back passage and are usually painless, while external piles form under the skin around the anus and can be sore.
Piles are very common in adults, and most people will have them at some point. They are not dangerous in most cases. Many people feel embarrassed and delay seeing a doctor, or try untested remedies, but early care is simple, quick and private, and it stops small piles from growing and bleeding more.
Why piles develop
Anything that raises pressure in the lower rectum for long periods can cause piles. Straining on the toilet because of hard, dry stools is the biggest cause. Sitting for a long time on the toilet, including while reading or using a phone, adds pressure on these blood vessels and makes them swell.
Pregnancy is a common trigger because of the weight of the growing baby, extra blood volume and hormonal changes that relax the veins. Long-term diarrhoea, heavy lifting at work or the gym, obesity, a low-fibre diet, a chronic cough and ageing also raise the risk. Piles often run in families.
Symptoms of piles
The most common sign is bright red blood on the toilet paper, dripping into the toilet or streaking the stool, usually without pain. Other symptoms include itching, a feeling of incomplete emptying, a mucus discharge and a soft lump that may come out during stools and go back on its own or need pushing back.
A sudden, very painful, bluish lump near the anus may be a blood clot in an external pile, called a thrombosed pile, and should be seen by a doctor. Sharp, cutting pain during stools with a little bright bleeding is more often a fissure, which is a small tear in the skin and needs different care.
How piles are diagnosed
A doctor can often diagnose piles by looking at the area and doing a gentle examination with a gloved finger. A short tube with a light, called a proctoscope, may be used to see internal piles. These checks take only a few minutes.
Because bleeding from the back passage can also come from fissures, polyps, inflammatory bowel disease or bowel cancer, the doctor may advise a colonoscopy, especially if you are over 50, have anaemia, weight loss or a change in bowel habit.
Treatment options for piles
Most piles improve with softer stools and less straining. Soothing creams, ointments or suppositories from a pharmacist can ease itching and discomfort for a short time. Some contain mild steroids, which should only be used briefly as advised. Doctors may also prescribe tablets that help strengthen small veins and reduce bleeding.
Piles that keep bleeding or come out often can be treated with simple day-care procedures such as rubber band ligation, injection or infrared treatment, usually without a hospital stay. Surgery is kept for large or troublesome piles that do not respond to other treatment, and your doctor will explain the choices.
Self-care and prevention
The aim is soft stools that pass easily without effort, so the swollen vessels can settle. These habits also help prevent piles from coming back after treatment. Pregnant women should ask their doctor before using any pile cream or laxative, as some ingredients are not suitable during pregnancy or breastfeeding.
- Eat more fibre: whole grains, dal, vegetables, fruits and salads
- Drink plenty of water through the day
- Do not strain or sit on the toilet for long; leave the phone outside
- Go when you feel the urge rather than holding it in
- Sit in a tub of plain warm water for a few minutes to ease soreness
- Keep the area clean and dry, and use soft, unscented tissue or water
When to see a doctor for piles
See a doctor for any bleeding from the back passage, especially the first time, rather than assuming it is piles. Also see a doctor if pain is severe, a lump will not go back, or symptoms last more than a week despite self-care. A doctor or pharmacist can recommend the right cream or stool softener and decide if a procedure is needed.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Bulk-forming laxatives such as ispaghula huskKeep stools soft so you do not strain.Follow the label or your pharmacist's advice and drink enough water.
- Local anaesthetic creams or ointments (such as lidocaine)Numb the area to relieve pain and itching.Use only for a few days; stop if the skin becomes irritated.
- Mild steroid-containing pile creamsReduce swelling and itching around the anus.Use only briefly as advised, as long use can thin the skin.
- Flavonoid venotonics such as diosmin with hesperidinMay help reduce bleeding and swelling of piles.Only on a doctor's advice, especially in pregnancy.
- Paracetamol (pain reliever)Eases pain from sore external piles.Follow the label or your pharmacist's advice; avoid codeine-based painkillers, which cause constipation.
See a doctor urgently if
- See a doctor urgently if you are bleeding heavily or passing clots from the back passage.
- See a doctor urgently if you feel faint, dizzy or very weak with bleeding.
- See a doctor urgently if a lump near the anus is very painful, hard or will not go back in.
- See a doctor soon if stools are black or dark red, or mixed with blood.
- See a doctor soon if bleeding comes with weight loss, tiredness or a change in bowel habit.
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.