Many people have piles, but the symptoms are not always obvious. Hemorrhoids cause noticeable symptoms for at least 50 percent of people in the United States (U.S.) before the age of 50 years.
This article will explore piles, their causes, how to diagnose, grade, and treat them, and what effects they might have on the body.
Here are some key points about piles. More detail and supporting information is in the main article.
- Piles are collections of tissue and vein that become inflamed and swollen.
- The size of piles can vary, and they are found inside or outside the anus.
- Piles occur due to chronic constipation, chronic diarrhea, lifting heavy weights, pregnancy, or straining when passing a stool.
- A doctor can usually diagnose piles on examination.
- Hemorrhoids are graded on a scale from I to IV. At grades III or IV, surgery may be necessary.
What are piles?
Internal piles occur more frequently than external piles.
Image credit: Mikael Häggström, 2012, own work
Piles are inflamed and swollen collections of tissue in the anal area.
They can have a range of sizes, and they may be internal or external.
Internal piles are normally located between 2 and 4 centimeters (cm) above the opening of the anus, and they are the more common type. External piles occur on the outside edge of the anus.
In most cases, the symptoms of piles are not serious. They normally resolve on their own after a few days.
An individual with piles may experience the following symptoms:
- A hard, possibly painful lump may be felt around the anus. It may contain coagulated blood. Piles that contain blood are called thrombosed external hemorrhoids.
- After passing a stool, a person with piles may experience the feeling that the bowels are still full.
- Bright red blood is visible after a bowel movement.
- The area around the anus is itchy, red, and sore.
- Pain occurs during the passing of a stool.
Piles can escalate into a more severe condition. This can include:
- excessive anal bleeding, also possibly leading to anemia
- fecal incontinence, or an inability to control bowel movements
- anal fistula, in which a new channel is created between the surface of the skin near the anus and the inside of the anus
- a strangulated hemorrhoid, in which the blood supply to the hemorrhoid is cut off, causing complications including infection or a blood clot
Piles is classified into four grades:
- Grade I: There are small inflammations, usually inside the lining of the anus. They are not visible.
- Grade II: Grade II piles are larger than grade I piles, but also remain inside the anus. They may get pushed out during the passing of stool, but they will return unaided.
- Grade III: These are also known as prolapsed hemorrhoids, and appear outside the anus. The individual may feel them hanging from the rectum, but they can be easily re-inserted.
- Grade IV: These cannot be pushed back in and need treatment. They are large and remain outside of the anus.
External piles form small lumps on the outside edge of the anus. They are very itchy and can become painful if a blood clot develops, as the blood clot can block the flow of blood. Thrombosed external piles, or hemorrhoids that have clotted, require immediate medical treatment.
Pregnancy may increase the risk of developing piles, as it causes increased pressure in the body.
Piles are caused by increased pressure in the lower rectum.
The blood vessels around the anus and in the rectum will stretch under pressure and may swell or bulge, forming piles. This may be due to:
- chronic constipation
- chronic diarrhea
- lifting heavy weights
- straining when passing a stool
The tendency to develop piless may also be inherited and increases with age.
A doctor can usually diagnose piles after carrying out a physical examination. They will examine the anus of the person with suspected piles.
The doctor may ask the following questions:
- Do any close relatives have piles?
- Has there been any blood or mucus in the stools?
- Has there been any recent weight loss?
- Have bowel movements changed recently?
- What color are the stools?
For internal piles, the doctor may perform a digital rectal examination (DRE) or use a proctoscope. A proctoscope is a hollow tube fitted with a light. It allows the doctor to see the anal canal up close. They can take a small tissue sample from inside the rectum. This can then be sent to the lab for analysis.
The physician may recommend a colonoscopy if the person with piles presents signs and symptoms that suggest another digestive system diseases, or they are demonstrating any risk factors for colorectal cancer.
In the majority of cases, piles resolve on their own without the need for any treatment. However, some treatments can help significantly reduce the discomfort and itching that many people experience with piles.
Diet and body weight may affect the risk of developing piles. Eating a high fiber diet and managing weight may help to prevent and treat the condition.
A doctor will initially recommend some lifestyle changes to manage piles.
Diet: Piles can occur due to straining during bowel movements. Excessive straining is the result of constipation. A change in diet can help keep the stools regular and soft. This involves eating more fiber, such as fruit and vegetables, or primarily eating bran-based breakfast cereals.
A doctor may also advise the person with piles to increase their water consumption. It is best to avoid caffeine.
Body weight: Losing weight may help reduce the incidence and severity of piles.
To prevent piles, doctors also advise exercising and avoiding straining to pass stools. Exercising is one of the main therapies for piles.
Several medicinal options are available to make symptoms more manageable for an individual with piles.
Over-the-counter (OTC) medications: These are available, including painkillers, ointments, creams, and pads, and can help soothe redness and swelling around the anus.
OTC remedies do not cure piles but can help the symptoms. Do not use them for more than 7 days in a row, as they can cause further irritation of the area and thinning of the skin. Do not use two or more medications at the same time unless advised to by a medical professional.
Corticosteroids: These can reduce inflammation and pain.
Laxatives: The doctor may prescribe laxatives if a person with piles suffers from constipation. These can help the person pass stools more easily and reduce pressure on the lower colon.
Around 1 in 10 people with piles will end up needing surgery.
Banding: The doctor places an elastic band around the base of the pile, cutting off its blood supply. After a few days, the hemorrhoid falls off. This is effective for treating all hemorrhoids of less than grade IV status.
Sclerotherapy: Medicine is injected to make the hemorrhoid shrink. The hemorrhoid eventually shrivels up. This is effective for grade II and III hemorrhoids and is an alternative to banding.
Infrared coagulation: Also referred to as infrared light coagulation, a device is used to burn the hemorrhoid tissue. This technique is used to treat grade I and II hemorrhoids.
Hemorrhoidectomy: The excess tissue that is causing the bleeding is surgically removed. This can be done in various ways and may involve a combination of a local anesthetic and sedation, a spinal anesthetic, or a general anesthetic. This type of surgery is the most effective for completely removing piles, but there is a risk of complications, including difficulties with passing stools, as well as urinary tract infections.
Hemorrhoid stapling: Blood flow is blocked to the hemorrhoid tissue. This procedure is usually less painful than hemorrhoidectomy. However, this procedure can lead to an increased risk of hemorrhoid recurrence and rectal prolapse, in which part of the rectum pushes out of the anus.
While they can be painful and debilitating, piles do not usually pose any ongoing threat to health and can be self-managed up to grades III or IV. If a complication develops, such as a fistula, this can become serious.
The surgical options for more advanced piles are normally outpatient procedures with minimal recovery time.