Piles (Haemorrhoids)

Piles (Haemorrhoids)

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.

Symptoms of Piles

  • 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

Causes of Piles

The primary causes of piles include:

genetic predisposition to piles
lack of fiber in the diet
inadequate fluid intake
sedentary lifestyle
straining while passing stool
constipation and diarrhea
constant sitting or standing for long hours at a stretch
sitting for long periods of time on the toilet
anal intercourse
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

Diagnosis Of Piles

  • 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.

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 -

  • Three 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.