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Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 5 minutes read

Piles, also known as hemorrhoids, are a very common problem that many people will encounter at some stage in their life. Many people do not seek medical attention for them, so it is unknown exactly how common they are. They are enlarged blood vessels in and around the anus which look like small lumps that can be red or purplish. Symptoms of piles can include blood after you go for a poop. They can also cause pain or itching around the anus. The blood from piles will usually be bright red, and usually seen on wiping or on top of the stools. People can also have no symptoms at all.

Sometimes piles can become thrombosed, which means they have no blood flow due to the blood clotting in the vessel. These are very painful and tender to touch, sometimes described as looking like a painful purple grape. Piles are not contagious, and cannot be passed on.

Doctor’s advice

Types of piles

There are three main types of piles (hemorrhoids):

  1. Internal -these develop inside the rectum and may not cause any noticeable symptoms unless they prolapse or protrude through the anus.

  2. External - these form under the skin around the anus and can be felt as a lump or bulge. They may cause pain, itching, and bleeding.

  3. Thrombosed - occur when blood clots form in external hemorrhoids, causing severe pain and inflammation.

Symptoms of Piles

Symptoms vary depending on the type and severity but may include:

  • Rectal bleeding during bowel movements.

  • Itching or irritation in the anal region.

  • Pain or discomfort, especially during bowel movements.

  • Swelling or lumps around the anus.

  • Mucus discharge from the anus.

Causes of Piles

Several factors may contribute:

Bowel movements. Chronic constipation or diarrhea can strain the rectal veins, leading to hemorrhoid formation.

Pregnancy. Increased pressure on the pelvic veins during pregnancy can cause hemorrhoids. Also, pregnancy can increase the risk of constipation.

Obesity. Excess weight can put pressure on the pelvic region, contributing to hemorrhoid development.

Sitting for prolonged periods. Sedentary lifestyles or occupations that require long periods of sitting can increase the risk of piles.

Low-fiber diet. Inadequate intake of dietary fiber can result in constipation, which is a common risk factor for hemorrhoids.

Do cold floors cause piles?

It is a myth that sitting on cold floors can cause piles. What does increase the risk of getting piles is anything that increases pressure in your abdomen, which in turn increases the pressure in the blood vessels in and around the anus. Constipation can increase the chance of hemorrhoids, as it causes straining when having a poop. Other causes include generally sitting and straining on the toilet for long periods of time, pregnancy, or if you are overweight.

How is piles diagnosed?

Diagnosing hemorrhoids typically involves a combination of medical history, physical examination, and possibly additional tests, including:

  • Rectal Examination - a healthcare provider may perform this to assess for internal hemorrhoids by inserting a gloved, lubricated finger into the rectum. This is the common method.

  • Anoscopy or proctoscopy - these procedures involve using a lighted tube to examine the inside of the anus and rectum for signs of hemorrhoids.

  • Sigmoidoscopy or colonoscopy - if bleeding is severe or other symptoms are present, a colonoscopy or sigmoidoscopy may be recommended to evaluate the entire colon for other potential causes of bleeding.

How do I treat piles?

Treatment for piles depends on the severity of symptoms and the type of hemorrhoids. Options may include:

  1. Lifestyle Modifications - dietary changes can help alleviate symptoms and prevent hemorrhoid recurrence, such as:

    • increasing fiber intake
    • staying hydrated
    • practicing good bowel habits,
  2. Topical Treatments - over-the-counter creams, ointments, or suppositories containing hydrocortisone, witch hazel, or numbing agents can provide relief from itching, pain, and inflammation. Examples include Anusol. Learn about the differences between the products.

  3. Warm salt baths - warm water baths with Epsom salts several times a day can help soothe anal discomfort and reduce swelling.

  4. Medications - may be recommended to manage pain and improve bowel movements:

  5. Minimally invasive procedures - to shrink or remove persistent or severe hemorrhoids such as rubber band ligation may be performed.

  6. Surgery of large, protruding, or thrombosed hamorrhoids that do not respond to other treatments.

How to prevent piles in the future

To reduce the risk of developing piles or prevent a recurrence, individuals can take several preventative measures, including:

  • eating a high-fiber diet rich in fruits, vegetables, whole grains, and legumes

  • staying hydrated by drinking plenty of water throughout the day

  • avoiding prolonged sitting or standing and incorporating regular physical activity into daily routines

  • practicing good bowel habits, including avoiding straining during bowel movements and using the toilet when the urge arises

  • maintaining a healthy weight and avoiding excessive straining during heavy lifting or strenuous activities

When should I see my doctor?

You should see your doctor if you have any bleeding from the rectum and you have not seen your doctor before. The first step is to confirm the diagnosis.

If you have been diagnosed, then you may opt to treat the piles with over-the-counter treatments. You should also see your doctor if you have any serious symptoms such as weight loss, night sweats or a change in your normal bowel habits.


You are fit for work if you have piles.

What will the doctor do?

The doctor will ask about your medical history and your symptoms. They will need to examine the area around your anus and will tell you if you have hemorrhoids.

If your piles are causing very severe problems, the doctor may refer you for treatment at the hospital which is usually done as an outpatient for a process called banding. This is where a small elastic band is put onto the hemorrhoid, stopping the blood from getting into it, and it eventually just falls off - this process usually isn't painful. There are other options that the doctor will discuss with you if banding is not suitable.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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