Piles (haemorrhoids): symptoms, causes and treatment

What piles are, why bleeding from the back passage still needs a check, how piles are examined and treated, and when to see a surgeon.

Also known as: Hemorrhoidectomy; Piles

What piles are

Everyone has cushions of blood vessels in the lining of the anal canal; they help keep the back passage closed. Piles, or haemorrhoids, are what doctors call these cushions when they become swollen, stretched or slip downwards, and start to bleed, hurt or come out.

Internal piles start inside the anal canal, above the point where the skin becomes sensitive, so they usually bleed without pain. As they enlarge they may come out (prolapse) on passing stool and go back by themselves, need pushing back, or stay outside. External piles lie under the skin around the anus. They can be itchy or sore, and if a blood clot forms inside one (a thrombosed pile), it becomes a hard, very painful purple lump.

In India, 'piles' is often used for any problem in the back passage. Several other conditions — a fissure (a small tear), a fistula, an abscess, skin tags, polyps and bowel cancer — cause similar symptoms and are treated quite differently. Getting the right diagnosis is the first step.

Symptoms

• Bright red bleeding — on the toilet paper, as drops in the pan or streaking the stool, usually painless
• A lump near the anus, or something that comes out after passing stool
• Itching or irritation around the anus
• Pain or discomfort, mainly with external or thrombosed piles
• Mucus discharge, or a feeling that the bowel has not fully emptied

Sharp, cutting pain while passing stool, lasting for some time afterwards, is more typical of a fissure than piles. Pain with swelling, fever or pus suggests an abscess. Dark blood mixed into the stool, or a change in bowel habit, points to a problem higher up the bowel.

Causes and who is at risk

Anything that raises pressure in the anal veins or pushes the cushions down over time can cause piles:

• Constipation and straining, often linked to a diet low in fibre and fluids
• Long periods sitting on the toilet — reading or using a phone makes this worse
• Long-standing diarrhoea
• Pregnancy and childbirth
• Heavy lifting, as in some jobs and gym training
• Ageing, as the supporting tissues weaken
• Being overweight or sitting for most of the day

Diets heavy in refined flour and polished rice, with few vegetables, fruit and pulses, and not drinking enough water in hot weather, are common contributors to constipation.

How it is diagnosed

Many people delay seeing a doctor out of embarrassment. The examination is brief, done in private, and is something doctors do every day. It usually includes:

• Digital rectal examination — a gloved, lubricated finger is gently passed into the back passage to feel for lumps or tenderness.
• Proctoscopy — a short, lit tube is used to look at the anal canal, where internal piles are seen. It takes a few minutes and is not usually painful.
• Colonoscopy — a camera test of the whole large bowel. It is advised if you are older, have a change in bowel habit, anaemia, weight loss, a family history of bowel cancer, or bleeding that does not look typical of piles.

Do not assume bleeding is 'just piles' because you have had piles before. Bowel cancer can cause similar bleeding, and it is much more treatable when found early.

Which doctor to see

A general physician can assess mild symptoms. Piles that keep bleeding, come out, or need a procedure are treated by a general surgeon — many have a special interest in the anus and rectum (proctology or colorectal surgery). A gastroenterologist is the right choice when the bleeding needs a colonoscopy, or when bowel symptoms suggest another condition such as inflammatory bowel disease.

You can find general surgeons in Bengaluru or gastroenterologists in Bengaluru on The Doctor Index, each with a registration you can check.

Treatment

Fibre, fluids and toilet habits

Fibre and fluids are the foundation for every grade of piles. More vegetables, fruit, whole grains and pulses, enough water, and a fibre supplement if your doctor suggests one, make stool softer and easier to pass. Go when you feel the urge, do not strain, and do not sit on the toilet for long. A warm sitz bath (sitting in a few inches of warm water) can ease soreness.

Creams and suppositories from a chemist can soothe itching and pain for a short time, but they do not shrink piles. Steroid-containing creams should not be used for more than a few days without medical advice, as they can thin the skin.

Clinic procedures

For internal piles that keep bleeding or prolapse, simple procedures can be done in the clinic or day-care unit, usually without a general anaesthetic. Rubber band ligation places a small band at the base of the pile, which then shrinks and falls off within days. Sclerotherapy injects a solution that shrinks the pile. Some centres use heat or infrared coagulation. More than one session may be needed.

Surgery

Larger piles, piles that stay outside, or those that return after clinic treatment may need an operation. A haemorrhoidectomy removes the piles and gives the lowest chance of recurrence, but recovery is more painful. A stapled haemorrhoidopexy lifts the piles back into place and is usually less painful in the short term, though they may return more often. Other options include ultrasound-guided tying of the feeding blood vessels and laser procedures. Your surgeon will decide based on the type and grade of piles and your preference. A recently thrombosed external pile is sometimes drained under local anaesthetic.

Prevention and aftercare

• Keep stool soft with fibre and water every day, not only during a flare
• Stay active — walking helps the bowel move
• Leave the phone outside the toilet
• Treat constipation or diarrhoea early
• After any procedure, follow the advice on pain relief, softeners and wound care, and keep the follow-up visit

When it is an emergency

Call 112 or 108, or go to the nearest emergency department, for:

• Heavy bleeding that does not stop, or bleeding with dizziness, fainting or a fast heartbeat
• Black, tarry stools
• Severe pain with fever, or a hot, swollen area near the anus
• A prolapsed pile that cannot be pushed back and is becoming dark, very painful or swollen

Questions to ask at your appointment

• Are these definitely piles, and what grade are they?
• Do I need a colonoscopy?
• Can these be treated with a clinic procedure, or do I need surgery?
• What is the recovery like, and how much time off work will I need?
• How likely are they to come back, and how can I prevent that?

Common questions

All gastroenterology conditions →

Sources

• MedlinePlus, US National Library of Medicine — Hemorrhoids
• American Society of Colon and Rectal Surgeons — Hemorrhoids
• MedlinePlus, National Library of Medicine — Hemorrhoids — Public-domain health-topic summary

Piles (haemorrhoids): symptoms, causes and treatment is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.

General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-1102.