Overview
Piles, also called haemorrhoids, are swollen and inflamed blood vessels in the lining of the back passage or under the skin around the anus.
Internal piles sit inside, are often painless and show themselves as bleeding. External piles form under the skin around the anus and tend to itch or form a tender lump.
Symptoms
- Bright red blood on the stool, on the paper or in the pan after a motion
- Itching or soreness around the anus
- A lump hanging down outside the anus, which may need to be pushed back
- One or more hard, tender lumps near the anus
- A feeling of still needing to pass stool after going
Symptoms come and go, and external piles often settle on their own within a few days.
When to see a doctor
See a doctor about any bleeding from the back passage, even when it looks like ordinary piles: other conditions cause the same bleeding, and some are easier to treat when found early. Also see a doctor if piles are no better after about a week of home treatment, if they keep returning, or if bleeding or a change in bowel habit has lasted three weeks or more.
Causes
The exact reason the vessels swell is not always clear, but anything that raises pressure around the back passage plays a part. Straining to pass hard stool is commonest, and so is sitting a long time on the toilet, for example while using a phone. The supporting tissue also weakens with age, which is why piles become more common later in life.
Risk factors
- Constipation and straining to pass stool
- Long-lasting diarrhoea, and a diet low in fibre
- Sitting on the toilet for long periods
- Pregnancy and childbirth
- Regular heavy lifting, and being overweight
- Older age
Complications
Piles themselves are rarely dangerous but can be wearing. An internal pile may come down through the anus and need pushing back, or stay outside, and an external one can become a hard, tender lump. The most important risk is not the piles at all: if bleeding is put down to piles without anyone looking, another cause can go unnoticed.
Prevention
- Eating more fibre, such as whole grains, dal, vegetables and fruit, with enough water
- Going to the toilet as soon as the urge comes, and not straining
- Not sitting on the toilet longer than needed
- Being active most days, and keeping to a healthy weight
- Treating constipation or long-lasting diarrhoea rather than putting up with it
Diagnosis
A doctor asks about the bleeding, the bowel habit and any pain, then examines around the anus, usually with an internal examination using a gloved finger.
A short look inside with a small instrument, called a proctoscopy, shows internal piles. If the story does not fit, or there are warning signs, a longer camera test of the lower bowel may look for other causes.
Treatment
Most piles settle with the changes listed under prevention, plus a warm bath, a cold pack, and gentle cleaning and patting dry. A pharmacist can suggest a cream, ointment or suppository for a few days, and a laxative if the stool is hard.
If that is not enough, a clinic can treat internal piles without a cut. Options include banding, where a tiny band is put around the base of the pile, an injection that shrinks it, or heat or infrared light.
Surgery is reserved for large or persistent piles. Operations include removing the piles, stapling them back into place, or tying off the vessels that feed them.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Blood after passing stool is just piles. Everyone gets it.”What is true?
Fact
Piles are the commonest cause, but bleeding from the back passage can also come from an anal fissure, an infection, inflammatory bowel disease, polyps or bowel cancer. Bowel cancer is easier to treat when it is found early, so bleeding is worth having checked rather than assumed.
Myth“Piles come from eating chillies and hot, spicy food.”What is true?
Fact
Piles are swollen blood vessels, and they are linked to straining, constipation, sitting a long time on the toilet, a diet low in fibre, pregnancy, heavy lifting and the tissues weakening with age. Changing those things helps far more than cutting out one food.
Myth“Any painkiller will do for the pain of piles.”What is true?
Fact
Paracetamol is usually suitable. Ibuprofen is not advised when the piles are bleeding, and painkillers containing codeine cause constipation, which makes piles worse. It is worth asking a pharmacist or doctor before taking something for the pain.
Myth“Once you have piles, an operation is the only way out.”What is true?
Fact
Most piles improve with more fibre, more fluid, not straining and short use of pharmacy creams. If that is not enough, the next step is usually a quick clinic procedure such as banding or an injection, done without a cut. Surgery is kept for severe or persistent piles.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
The bleeding is bright red and only on the paper. Is that definitely piles?
It is the pattern piles usually cause, but it is not proof. An anal fissure, a polyp, inflammatory bowel disease and bowel cancer can all bleed in the same way. A doctor can usually sort this out with a simple examination, and that one visit is worth making.
Will piles go away on their own?
Often, yes. External piles frequently settle within a few days, and symptoms tied to constipation improve once the stool is softer and straining stops. Piles that keep returning, or that are no better after about a week of home treatment, should be looked at.
Do piles in pregnancy need different treatment?
Pregnancy makes piles more likely because of the pressure and the hormonal changes, and they often improve after the baby is born. Not every cream or laxative is suitable in pregnancy, so it is best to ask the doctor or midwife rather than buy something over the counter.
Is banding painful?
Banding is done in a clinic and most people feel pressure or a dull ache rather than sharp pain, because the area treated has few pain nerves. There can be some aching and a little bleeding for a few days afterwards. Your doctor will tell you what to expect and what to watch for.
