What are piles?

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 weekTrusted Source 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%Trusted Source 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 halfTrusted Source of people over the age of 50 develop piles.
• Weight: Research suggests that being overweight may increaseTrusted Source a person’s chance of developing piles.
• Diet: Eating a diet low in fiber may increase the likelihoodTrusted Source 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.