Piles (haemorrhoids) 



An expert explains what haemorrhoids are, who gets them, and how to get rid of them.

Media last reviewed: 30/04/2013

Next review due: 30/04/2015

Types of haemorrhoids

Haemorrhoids can occur internally (inside the anus) or externally (outside the anus).

Internal haemorrhoids develop 2-4cm above the opening of the anus. They can be classified depending on their size and severity. Internal haemorrhoids are classified as follows:

  • first degree - small swellings that develop on the inside lining of the anus and are not visible from outside the anus
  • second degree - larger swellings that may come out of your anus when you go to the toilet before disappearing inside again
  • third degree - one or more small, soft lumps that hang down from the anus and can be pushed back inside
  • fourth degree - larger lumps that hang down from the anus and cannot be pushed back inside

Haemorrhoids that are associated with external blood clots beneath the skin are known as perianal haematoma. They are less common than internal haemorrhoids and develop on the outside edge of the anus.

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Haemorrhoids, also known as piles, are swellings that contain enlarged and swollen blood vessels in or around the rectum and anus.

In most cases, haemorrhoids are mild and some people do not experience any symptoms. In more severe cases, symptoms may include: 

  • bleeding after passing a stool (the blood will be bright red)
  • a pile may move down, outside of the anus (prolapse) and may need to be pushed back after passing a stool
  • itchiness around the anus

Read more about the symptoms of haemorrhoids.

Haemorrhoids are sometimes caused by prolonged constipation. If you strain when you go to the toilet it can put pressure on the blood vessels in and around your anus, causing them to swell.  

Things that increase the risk of piles include:

  • being overweight
  • being  pregnant
  • being over 50 years of age

Read more about the causes of haemorrhoids.

Read more about piles in pregnancy.

Should I see my GP?

The symptoms of haemorrhoids often clear up on their own or treatment is available over-the-counter at pharmacies (see below). However, speak to your GP if your piles do not get better or if you experience pain or bleeding.

Haemorrhoids can be easily diagnosed by an internal examination of your back passage.

Read more about diagnosing haemorrhoids.

Treating piles

Haemorrhoid symptoms often settle down after a few days without treatment. However, creams and ointments are available to reduce any itching or discomfort.

Making lifestyle changes to keep your stools soft and regular is usually the first recommendation for treating piles.

Eating wholegrain bread and cereal and fruit and vegetables will increase fibre in your diet and you should also drink plenty of water.

If your haemorrhoid symptoms are severe, there are a number of treatment options available to remove them.

For example, banding is a procedure where a very tight elastic band is put around the base of the haemorrhoid to cut off its blood supply. The haemorrhoid should fall off within seven days.

Surgery is also sometimes recommended to treat large haemorrhoids.

Read more about treating haemorrhoids, surgery for haemorrhoids and preventing haemorrhoids.

Page last reviewed: 24/04/2012

Next review due: 24/04/2014


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The 9 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Worcester69 said on 14 April 2014

I have 3 large lumps outside my anus about the size of 50ps no cream is Helping, There very hard and very painful..should i bother my Gp?

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foysal 2412 said on 17 March 2014

Now a days because of our food habit almost 1of every 2person suffering from piles. Basically its getting worse if your diet chart contains red meat like beef, lamb, and pork. Whatever Avril said i do agree with that but i knew my mom used this therapies but it wont help for cure just short term remedies from pain. My mom had three times operation for piles. So my suggestion is keep enough vegetable and salad will help more and will be a prevention method as well as minimum 3litres of water each day. Thanks

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Avril Elaine said on 01 August 2013

I have a simple method for treating external piles which does not require ointment or an operation, merely water. When you have a shower, direct the water jet at the pile. You will feel a sharp pain when you have found the correct place. Continue to direct the water at the sore spot until the pain subsides. This will take a few seconds. That is it. It is so simple and it has worked for me every time so far. I hope that this will help you.

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petuna said on 18 April 2013

I wondwr if piles can be caused by stress. I have been under stress for about 8 years and have suffer withthem increasingly during that time

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MissPickle said on 13 October 2012

I think I suffered from internal piles for 21/2months. For me this was a dull, achy, constant pain and feeling full at the base of the bottom which came on quite suddenly one day. Reading all the literature and testimonials on-line, I conclude that the causes and symptoms differ widely and one needs to find the cause of the irritation to the bowel which is making it too hard (constipation) or too easy (diohorrea) to pass poos. Then if you can make it stop, you will get chance of getting better (gradually). If it helps anyone; I had a bout of IBS caused be eating too much fibre i.e. watery fruit such as melon and pineapple causing me chronic diohorrea. When I realised this was causing me the problem, I stopped eating it. But it still took 11/2 months for the irritation to really go away especially if I indulged in something fibourous. But all symptoms are completely gone now. I hope this helps someone as I was so distracted and grumpy all the time when I had piles. My doctor was no help at all with the piles symptoms but did point out I had IBS which led me to help myself.

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MissPickle said on 29 August 2012

Does anyone know if piles can start as a result of a strain to the lower back?

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sweedlepipe said on 10 August 2012

Hi Moonpig,

I've heard it said that: 'A GP's job is to stand between you and treatment'. Your husband's GP sounds to be doing her job well. Fortunately, not all GP's do their job to such a high standard, so I would suggest you ask your husband to see a different one or insist on some proper treatment. He deserves it because hemorrhoids can taint your quality of life. Good luck!

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moonpig2011 said on 08 October 2011

My husband just visited his GP and complained of probable haemorrhoids which he has suffered in silence for some time. Worried that in the absence of a proper diagnosis he might be suffering from something more serious, he sought reassurance and some practical advice. He has already tried losing weight, adding fibre to his diet etc., but because he does heavy lifting in the construction industry, these measures have helped not one bit. His GP did not deem it necessary to examine him and told him that surgery was 'a waste of time as the haemorrhoids just come back'. She prescribed the sort of cream which can be bought over the counter at any pharmacy.
I therefore sought advice here and at BUPA's site. What a marked contrast!

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NHSC Super User said on 17 May 2011

Pretty generic content about piles. I suffered a few ago with them my doctor recommended surgery to remove them (I'm a male 35). At the same time I was having heart palpitations, the nurse at my ECG scan asked if I drank lots of tea, coffee or soft drinks. Yes, I was drinking up to ten cups of tea a day plus a can of coke or two. That's why your having palpitations she said too much caffeine! Within months of cutting out caffeine in my diet and having more fibre at breakfast my piles and palpitations went. I felt 99% sure the caffeine was triggering my piles. Drink decafe now, and haven't had piles in 4-5 years. My doctor never really advised me to change my diet! Maybe of help to sufferers, a painful condition.

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