Piles are swollen veins in the lower anus and rectum. This swelling can cause localized inflammation of other tissues. Piles is another term for hemorrhoids.

Many people have piles, but the symptoms are not always obvious. Hemorrhoids cause noticeable symptoms for at least 50% of people in the United States over 50 years of age.

This article will explore piles, their causes, how to diagnose, grade, and treat them, and what effects they might have on the body.

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Piles are the result of swollen veins in the lower anus and rectum. They can cause tissue growths in and around the anus and can lead to significant discomfort. These growths can vary in size and location.

Internal vs. external

Internal piles occur within the rectum and are usually not visible during an external examination. However, in some cases, an external pile may grow to protrude outside of the anus. The medical term for this is prolapsed hemorrhoid.

Medical professionals grade internal piles on a four-point scale.

  • Grade I: The growth does not cause symptoms and does not protrude out of the anus.
  • Grade II: The piles may prolapse from the anus but return inside independently.
  • Grade III: The piles prolapse and only recede within the anus with manual intervention.
  • Grade IV: The piles prolapse outside of the anus and a person cannot push them back in.

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 because the clot can block blood flow. Thrombosed external piles, or hemorrhoids that have clotted, require immediate medical treatment.

In most cases, the symptoms of piles are not serious and resolve on their own.

An individual with piles may experience the following symptoms:

  • painful lumps in and around the anus
  • itching and discomfort around the anus
  • discomfort during and after passing stools
  • bloody stools

Piles can escalate into a more severe condition. These include:

  • excessive anal bleeding, possibly leading to anemia
  • infection
  • fecal incontinence
  • anal fistula
  • strangulated hemorrhoid, in which anal muscles cut off blood supply to the hemorrhoid

However, many people with piles may not experience any symptoms.

When to contact a doctor

A person should seek medical assistance if their piles persist for more than one week of home treatment or if they experience consistent bleeding from their rectum.

Piles result from increased pressure in the lower rectum.

The blood vessels around the anus and 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

Risk factors

Certain factors may increase a person’s risk of developing piles, including:

  • Pregnancy: Up to 50% of people experience hemorrhoids during pregnancy. This is due to increased pressure on the pelvis, a person having a higher blood volume, and a higher incidence of constipation.
  • Age: Piles are more common in older adults. Around half of people over the age of 50 develop piles.
  • Weight: Research suggests that being overweight may increase a person’s chance of developing piles.
  • Diet: Eating a diet low in fiber may increase the likelihood of a person having piles.

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 for analysis.

The physician may recommend a colonoscopy if the person with piles presents signs and symptoms that suggest another digestive system disease, or they are demonstrating any risk factors for colorectal cancer.

In most 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.

Lifestyle changes

A doctor will initially recommend some lifestyle changes to manage piles.

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. 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:

  • Pain relievers: Over-the-counter pain relievers such as aspirin and ibuprofen can reduce discomfort.
  • Stool softeners: Stool softeners and laxatives can make passing stools easier, which can reduce pain from piles.
  • Corticosteroids: Corticosteroid creams and ointment can reduce inflammation, pain, and itching.

Surgical options

If a person has severe prolapsed piles or internal piles that are bleeding, surgery may be necessary. Surgical procedures for piles include:

  • Banding: The doctor places an elastic band around the base of the pile, cutting off its blood supply. The hemorrhoid will typically fall off within a week.
  • Sclerotherapy: A doctor will inject medicine into the hemorrhoid to make it shrink and eventually shrivel up. This is effective for grade II and III hemorrhoids and is an alternative to banding.
  • Infrared coagulation: During this procedure, a surgeon will use an infrared light device to burn the hemorrhoid tissue.
  • Hemorrhoidectomy: This type of surgery involves the total removal of hemorrhoid tissue. It is the most effective option for completely removing piles, but there is a risk of complications, including difficulties with passing stools.
  • Hemorrhoid stapling: During this procedure, a surgeon will use staples to block blood flow to the hemorrhoid tissue.

Learn more about the surgical treatments for piles here.

People can lower their risk of developing piles with a range of lifestyle alterations, including:

  • Eating a healthful diet: Staying hydrated and eating a diet rich in high-fiber foods can help keep stools soft and make their passing easier.
  • Avoiding straining when passing stools: Straining when passing stools can increase the risk of developing piles.
  • Avoiding heavy lifting: Regular heavy lifting is a risk factor for piles. Limiting heavy exertion and practicing proper lifting techniques can help a person prevent the development of piles.
  • Maintaining a moderate weight: Being overweight raises the risk of having piles.
  • Staying active: Exercise can help food passage through the digestive system and make stools more regular. This can reduce the risk of piles.

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.

Piles is another term for hemorrhoids. They are swollen veins in the lower anus and rectum and can cause lumps in and around the anus. Piles vary in size and location and many people with piles do not realize they have them.

Piles can be the result of overexertion, chronic constipation, and straining when passing stool. Many piles resolve on their own, but visible, painful piles may require surgery to remove.

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