What are piles (hemorrhoids)?

Mild piles (hemorrhoids) can often go unnoticed, but noticeable symptoms can include pain, itching, bleeding, and external lumps.
Mild piles (hemorrhoids) can often go unnoticed, but noticeable symptoms can include pain, itching, bleeding, and external lumps.

Piles, or hemorrhoids, occur when the veins within the rectum and anus (organs at the end of your digestive tract that pass stools) become inflamed and swollen. Piles usually aren’t serious and heal within a week, but severe cases may require medical treatment.

Signs and symptoms of piles (hemorrhoids)

Mild piles can often go unnoticed, but they have a range of symptoms, especially regarding your bowel movements.

Pain

Piles can range from painless to severely painful. Sharp pain or a pinching feeling may occur when you’re sitting on the toilet or passing a stool. The anus or area between your buttocks may also feel sore, especially after a bowel movement.

Itching

Piles can cause an itching sensation around the anus. Often, scratching can make it itch more.

Bleeding

All types of piles can bleed, even if you’re not experiencing any pain. Bright red blood can appear in the stools and the water surrounding it, or on used toilet paper. 

Lumps

Tender lumps of skin can develop outside the anus. You may be able to see one, or feel it as you wipe after a bowel movement.

Types of piles (hemorrhoids)

Piles can be internal or external. Internal piles develop inside the anus and are not visible on the skin around it, while external piles develop on the skin outside the anus. Internal piles fall under four grades, I to IV.

  • Grade I: The pile is completely internal—it doesn’t extend out of the anus. You can’t see or feel it on the skin. 
  • Grade II: The pile is internal but can extend outside of the anus while straining or passing a stool. After passing a stool, the pile goes back inside by itself.
  • Grade III: Like grade II, this type of pile extends outside the anus while straining but won’t go back inside on its own — you must push it back in. 
  • Grade IV: The pile extends outside the anus and cannot be pushed back in. See a doctor immediately if you think you have this type.

Causes of piles (hemorrhoids)

Piles can have several different causes, usually having to do with increased pressure and strain around the pelvis and rectum. This increased pressure can push more blood to the veins in that area, causing them to swell.

Pregnancy/childbirth

During pregnancy and childbirth, the enlarged uterus and expanded vaginal canal increase pressure on the nearby pelvis and rectum, creating piles. Hormonal changes during pregnancy can also cause piles. 

Over-long bathroom trips

The angle of your backside on the toilet seat is low enough to cause blood to pool in your anal veins if you sit in the same position for too long. 

Constipation

The strain of constipation can also cause too much blood to flow to your anal tissue, creating swollen veins.

Heavy lifting

Like constipation, lifting heavy objects increases blood flow to your muscles. This includes your rectal and anal muscles, even if you’re not using them directly.

QUESTION

Everyone has hemorrhoids. See Answer

When to see the doctor for piles (hemorrhoids)

Usually, piles heal on their own and don’t require medical attention. But contact your doctor if you notice blood while you’re passing a stool. Bright red blood generally comes from the lower digestive tract (intestines, anus), while black or tarry-appearing blood comes from higher up in your body. 

The most common reasons for bright blood in the stool are usually not serious, but sometimes it can indicate a more serious underlying illness. If your piles often reappear, don’t heal on their own at home, or cause you severe pain, contact your doctor.

Diagnosis of piles (hemorrhoids)

A doctor can perform a rectal exam to determine whether you have piles. With a gloved and lubricated finger, they will gently feel inside and around your anus to look for any growths or lumps, internal or external piles, leakage, or other symptoms.

Treatments for piles (hemorrhoids)

You can treat most piles at home, but severe cases might require a doctor's help.

Dietary

Since constipation is a common cause of piles, keeping stools soft and easy to pass is key. Try to eat foods containing fiber, a nutrient that helps your body digest food. 

High-fiber foods include whole grains and bran, fruits and vegetables, and beans. Limit the amount of low-fiber foods you eat, like chips, meat, ice cream, and cheese. 

Drinking lots of water and clear liquids, like chicken soup, can also help soften your stools. 

Sitz bath

A sitz bath—sitting in warm water so it surrounds your anal area—can reduce pain and itching. You can use a sitz bath bowl or a bathtub.

Professional treatments

For severe piles, a doctor may perform rubber band ligation (tying a small band to the base of the pile to cut blood flow), sclerotherapy (chemical injection), or cryotherapy (freezing with special gas or liquid). Surgery may be necessary for piles that don’t respond to other treatments.

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Medically Reviewed on 3/11/2021
References
American Family Physician: Hemorrhoids: "Diagnosis and Treatment Options."

American Society of Colon & Rectal Surgeons: "Pruritus Ani Expanded Version."

Aurora Health Care: "Hemorrhoid Treatment."

GI Society: "Hemorrhoids."

Canadian Family Physician: "Hemorrhoids in pregnancy."

Geisinger: "How long is too long on the potty?"

Harvard Health Publishing: "Hemorrhoids and what to do about them."

National Institute of Diabetes and Digestive and Kidney Diseases: "Diagnosis of Hemorrhoids."

National Institute of Diabetes and Digestive and Kidney Diseases: "Eating, Diet & Nutrition for Hemorrhoids: What should I eat if I have hemorrhoids?."

Saint Luke's: "Taking a Sitz Bath."

SCL Health: "Hemorrhoids."

UnityPoint Health: "Blood in Stool: What Does it Mean?"