What is piles?

Piles are swellings or swollen haemorrhoids that occur inside and around the anus, and along the anal canal. Haemorrhoids are masses, clumps, cushions of tissue full of blood vessels, support tissue, muscle and elastic fibers in the anal canal.
Everyone has haemorrhoids. However, when the haemorrhoids guarding the anal passage become too big due to inflammation, so that the vein walls become stretched, thin, and irritated by passing bowel movements, that is when piles develops.

In most cases, piles goes away on its own.

Piles can be broadly classified into two categories:

  • Internal Piles – are located far within the rectum, and can’t be seen or felt. The only symptom is usually bleeding.
    Internal piles can be classified into 4 grades:

    • Grade1: These are tiny haemorrhoids within the lining of the anus.

    • Grade 2: These haemorrhoids too lie within the anus and are slightly larger than grade 1 haemorrhoids. These haemorrhoids may get pushed out while passing stool but return to the original position on their own.

    • Grade 3: These are also known as ‘prolapsed haemorrhoids’. They appear outside the anus. The patient can push them back in by pressing against them with his fingers.

    • Grade 4: These haemorrhoids cannot be pushed back and stay outside the anus at all times. They need to be treated by a doctor who usually suggests a surgery.

  • External Piles –  are located around the anus right under the skin, where there are many pain-sensing nerves. They, therefore, hurt as well as bleed.

Anyone at any age can be affected by piles. Though it has been observed that people over 45 years of age usually get affected by piles.

About 50% of people experience this condition at some time in their life. Women who are pregnant too experience it. Though it is not clear what causes haemorrhoids, researchers think this might be an inherited condition of weak veins or varicose veins leading to haemorrhoids.

How does piles occur?

Haemorrhoids are masses, clumps, cushions of tissue full of blood vessels, support tissue, muscle and elastic fibers in the anal canal. Piles are haemorrhoids that have become inflamed.

Internal haemorrhoids form when blood vessels inside the rectum become swollen and engorged.

External haemorrhoids can occur due to increased pressure caused by obesity, pregnancy, sitting or standing for long hours at a stretch, straining on the toilet, coughing, sneezing, vomiting, and holding your breath while straining to do strenuous physical labour.

Who is prone to piles?

Some people are more prone to developing piles than others. There could be a variety of reasons for it:

  • genetic predisposition to piles, meaning weak veins can be genetic leading to weak rectal vein walls or week venous valves

  • less fiber in the diet can cause constipation which can lead to the formation of piles

  • poor bathroom habits

  • pregnancy

  • excessive coughing or sneezing

  • constant sitting or standing for long hours at a stretch

  • excessive straining, rubbing or cleaning around the anus

  • regularly holding breath while straining to perform some physical labour

  • being obese

What are the causes of piles?

The primary causes of piles include:

  • genetic predisposition to piles

  • lack of fiber in the diet

  • inadequate fluid intake

  • sedentary lifestyle

  • stress

  • straining while passing stool

  • constant sitting or standing for long hours at a stretch
  • sitting for long periods of time on the toilet

  • anal intercourse

  • pregnancy

  • constant heavy lifting

  • being obese

  • previous surgery of bowel

  • constriction of intestine following a surgery

  • spinal cord injury that leads to bladder and rectal dysfunction

  • dysfunction of the floor of pelvis

What are the symptoms of piles? How is piles diagnosed?

The symptoms of piles include:

  • bright red bleeding from the anus. Blood may streak the bowel movement or the toilet paper.

  • pain during bowel movements

  • painful swelling or a lump near the anus

  • anal itching

  • mucous discharge from the anus

  • hard lump around the anus

  • area around the anus becomes red and sore



If the doctor suspects you have piles, he will perform a visual examination of your anus to diagnose haemorrhoids. He may also perform a digital rectal exam to check any sign of piles within the anus.
The doctor may also prescribe an additional test called a sigmoidoscopy.

A sigmoidoscopy (a small fibre-optic camera) involves your doctor using a small camera to diagnose an internal haemorrhoid. The sigmoidoscope is fitted into a small tube and inserted into your rectum.

It provides a clear view of the inside of your rectum and displays the abnormalities if any within the rectum. The doctor may also prescribe other tests such as colonoscopy, anoscopy, and proctoscopy which can clearly show internal haemorrhoids if any.

What are the complications of piles?

The complications of piles include:

  • bleeding during bowel movements

  • anemia

  • pain during bowel movements

  • piles cause complications associated with hygiene, as the anal area becomes difficult to clean after defecation

  • poor hygiene around the anal area can lead to several infections

  • itchiness around the anal area

  • gangrene, if the blood supply to an internal haemorrhoid is cut off

What is the treatment for piles?

Medical Treatment

Piles often clear up on their own but may require treatment or even surgery if the symptoms are severe.

The treatment of piles varies for internal and external piles.

Grade one, and two, of internal haemorrhoids, is usually treated with medicine and a planned diet of fibrous non-spicy food. In some cases, the doctors may also prescribe a topical cream.

Grade three of internal haemorrhoids is also treated with medicine and a change of diet but may require surgical intervention if the symptoms are severe. Treatment of grade four internal piles requires prompt surgical intervention especially if gangrenous tissue is found.

To treat external piles your doctor might suggest hemorrhoid creams, or ice packs to reduce the swelling. If the case is too severe, the doctor may suggest surgery which can include:

  • removal of haemorrhoids

  • using an infrared photo, laser, or electrical coagulation to burn tissue affected by piles

  • sclerotherapy to eliminate varicose veins which could be the cause of piles


Exercising can easily reduce the symptoms of piles. You can go for exercises such as :

  • brisk walking

  • deep breathing exercises

  • stretching exercises

  • aerobics

  • kegel exercises 3 times everyday –  the steps for which are:

    • contracting your pelvic muscles. It is akin to the action you do when you hold urination.

    • squeeze and hold for three seconds then relax for another 3 seconds.

    • repeat the exercise 10 times each session, until you can do as many as 15 repetitions.