What are Piles?

Piles are inflamed and swollen collections of tissue in the anal area. They can have a range of sizes, and they may be internal or external. Internal piles are normally located between 2 and 4 centimeters (cm) above the opening of the anus, and they are the more common type. External piles occur on the outside edge of the anus.

External hemorrhoids can occur due to increased pressure caused by obesity, pregnancy, sitting or standing for long hours at a stretch, straining on the toilet, coughing, sneezing, vomiting, and holding your breath while straining to do strenuous physical labour.

Symptoms of Piles:How Piles causes

In most cases, the symptoms of piles are not serious. They normally resolve on their own after a few days. An individual with piles may experience the following symptoms:

→ A hard, possibly painful lump may be felt around the anus. It may contain coagulated blood. Piles that contain blood are called thrombosed external hemorrhoids.
→ After passing a stool, a person with piles may experience the feeling that the bowels are still full.
→ Bright red blood is visible after a bowel movement.
→ The area around the anus is itchy, red, and sore.
→ Pain occurs during the passing of a stool.

→ A strangulated hemorrhoid, in which the blood supply to the hemorrhoid is cut off, causing complications including infection or a blood clot

Piles are classified into four grades:

→ Grade I: There are small inflammations, usually inside the lining of the anus. They are not visible.

→ Grade II: Grade II piles are larger than grade I piles, but also remain inside the anus. They may get pushed out during the passing of stool, but they will return unaided.

→ Grade III: These are also known as prolapsed hemorrhoids, and appear outside the anus. The individual may feel them hanging from the rectum, but they can be easily re-inserted.

→ Grade IV: These cannot be pushed back in and need treatment. They are large and remain outside of the anus.

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, as the blood clot can block the flow of blood. Thrombosed external piles, or hemorrhoids that have clotted, require immediate medical treatment.

Risk Factors:Piles Causes due to Lack of Regular Activity

While bowel movement problems are the most common causes of hemorrhoids, there are certain lifestyle factors that can increase a person’s risk both directly and indirectly.

Poor Hydration

Dehydrated or drinking less than eight glasses of water per day (roughly half a gallon) can contribute to constipation and, therefore, the development of hemorrhoids.

Low-Fiber Diet

Dietary fiber is essential to digestive health, and many people simply don’t get enough. Low-fiber diets (with less than 25 to 30 grams of fiber per day) can significantly increase your risk of constipation.

Diets rich in the following foods can significantly increase your risk of constipation:

→ Cheese
→ Chips
→ Fast food
→ Ice cream
→ Prepared foods, including frozen meals and snack foods

Hemorrhoids are a common feature in many health conditions, some serious and others not-so-serious. These include:

→ Anal injury, such as from anal sex
→ Ascites (the accumulation of fluid in the abdominal cavity, often seen in advanced liver disease)
→ Inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis
→ Obesity: Excessive abdomen girth and weight places stress on the muscles of the pelvic floor and, in turn, the hemorrhoid cushion.
→ Rectal prolapse

Because many of these conditions are serious and/or treatable, it is important not to ignore any hemorrhoid that is either worsening or failing to improve.While hemorrhoids can sometimes bleed, you should see a doctor if the bleeding is persistent and is accompanied by abdominal pain, changes in bowel habits, bloody stools, and unexplained weight loss. This may be a sign of colon or rectal cancer, both of which require immediate attention.The same goes for chronic diarrhea and constipation. Neither should be considered normal, and steps should be taken to identify any underlying cause (such a lactose or gluten intolerance) that might explain or contribute to the condition.


Hemorrhoids are also a common occurrence during pregnancy. While the pressure exerted by the weight of the baby can contribute to their development, hormonal changes can also cause blood vessels to swell excessively.During the pregnancy itself, the increased size of the uterus can exert pressure on the inferior vena cava, a large vessel on the right side of the body that receives blood from the lower limbs. Doing so impedes the flow of blood back to the heart and causes any vessels below the uterus to dilate, including those of the hemorrhoid cushion.Childbirth can place further strain by the sheer force of the labor contractions, leading to the development of hemorrhoids after delivery. It is estimated that as many as 35 percent of women will develop hemorrhoids during the course of her pregnancy. The risk typically increases with each subsequent birth.


Genetics can also play a role in the development of hemorrhoids. One such example is an inherited disorder called Ehlers-Danlos syndrome (EDS) in which the lack of collagen can lead to the impairment of pelvic floor tissues. Hemorrhoids are a common symptom of EDS and can sometimes foreshadow a more serious complication known as rectal prolapse in which the bowel falls partially or completely out of the body.Another commonly noted defect is the absence of valves within hemorrhoidal veins, which can lead to excessive vascular pressure and swelling.

Investigation or Diagnosis:

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. This can then be sent to the lab 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.

Treatment Options:Treatment Options for Piles

In the majority of cases, piles resolve on their own without the need for any treatment. However, some treatments can help significantly reduce the discomfort and itching that many people experience with piles.

Lifestyle changes

Diet and body weight may affect the risk of developing piles. Eating a high fiber diet and managing weight may help to prevent and treat the condition. A doctor will initially recommend some lifestyle changes to manage piles.


Piles can occur due to straining during bowel movements. Excessive straining is the result of constipation. A change in diet can help keep the stools regular and soft. This involves eating more fiber, such as fruit and vegetables, or primarily eating bran-based breakfast cereals.

A doctor may also advise the person with piles to increase their water consumption. It is best to avoid caffeine.

Body weight

Losing weight may help reduce the incidence and severity of piles.

To prevent piles, doctors also advise exercising and avoiding straining to pass stools. Exercising is one of the main therapies for piles.


Several medicinal options are available to make symptoms more manageable for an individual with piles.

Over-the-counter (OTC) medications: These are available over-the counter or online. Medications include painkillers, ointments, creams, and pads, and can help soothe redness and swelling around the anus.OTC remedies do not cure piles but can help the symptoms. Do not use them for more than 7 days in a row, as they can cause further irritation of the area and thinning of the skin. Do not use two or more medications at the same time unless advised to by a medical professional.


These can reduce inflammation and pain.


The doctor may prescribe laxatives if a person with piles suffers from constipation. These can help the person pass stools more easily and reduce pressure on the lower colon.

Surgical options

Around 1 in 10 people with piles will end up needing surgery.


The doctor places an elastic band around the base of the pile, cutting off its blood supply. After a few days, the hemorrhoid falls off. This is effective for treating all hemorrhoids of less than grade IV status.


Medicine is injected to make the hemorrhoid shrink. The hemorrhoid eventually shrivels up. This is effective for grade II and III hemorrhoids and is an alternative to banding.

Infrared coagulation: Also referred to as infrared light coagulation, a device is used to burn the hemorrhoid tissue. This technique is used to treat grade I and II hemorrhoids.


The excess tissue that is causing the bleeding is surgically removed. This can be done in various ways and may involve a combination of a local anesthetic and sedation, a spinal anesthetic, or a general anesthetic. This type of surgery is the most effective for completely removing piles, but there is a risk of complications, including difficulties with passing stools, as well as urinary tract infections.

Hemorrhoid stapling

Blood flow is blocked to the hemorrhoid tissue. This procedure is usually less painful than hemorrhoidectomy. However, this procedure can lead to an increased risk of hemorrhoid recurrence and rectal prolapse, in which part of the rectum pushes out of the anus.

Follow up

Hemorrhoids can be recurrent and are more likely to occur in those who have had symptoms in the past. To keep hemorrhoids away, doctors recommend the following:

A diet rich in high-fiber foods

Eating more fruits, vegetables and grains softens the stool and increases its bulk, which will help lessen the straining that can cause hemorrhoids or worsen symptoms from existing hemorrhoids. Add fiber to the diet slowly to avoid gas.

Drinking plenty of liquids

The amount of daily fluid requirements depends on age, sex, health, activity level and other factors. In general, six to eight, 8-ounce glasses of water or no sweetened drinks is sufficient.

Taking fiber supplements

Over-the-counter products such as psyllium (Metamucil®) and methylcellulose (Citrucel®) can help keep stools soft and regular. Check with your doctor about using stool softeners. If fiber supplements are used, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, fiber supplements can cause constipation or make constipation worse. Add fiber to your diet slowly to avoid gas.


Staying active helps to reduce pressure on veins, which can occur with long periods of standing or sitting, and to help prevent constipation. Exercise also can help you lose excess weight that may be contributing to hemorrhoids. In general, exercising at least 30 minutes daily, five days a week is recommended.

Avoiding long periods of standing or sitting

Sitting too long, particularly sitting on the toilet for long periods can increase the pressure on the veins in the anus.

Eliminating straining: Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum and may lead to hemorrhoids.


Piles or hemorrhoids are caused due to increased pressure or straining while passing stools or due to weak muscles around the anus. This leads to bulging and swollen blood vessels that often protrude and lumps while passing stools. These may bleed or may lead to discomfort, pain and itching around the anus.There are several lifestyle changes that may be adopted to reduce the symptoms of piles and reduce episodes of aggravated piles in susceptible individuals. These include consuming fibre in your diet, practicing good bowel habits and so forth. 1-5

Fibre in diet and prevention of piles

Inclusion of at least 25 to 30 grams of insoluble fibers in diet per day: this can be taken in normal diet in form of high fibre foods like fruits, vegetables, whole grains, cereals, and etc.These fibers cause absorption of water in the stools within the colon. This makes the stools softer and increases the volume. This reduces the straining and pressure on the anal blood vessels. People with risk of hemorrhoids should choose high fiber breakfast cereals. Products with five grams of fiber per serving should be chosen. There are also over the counter high-fiber supplements that are available for these at-risk individuals.

Diet should be low in fat and red meat since these predispose to constipation. Other foods like peas, beans and lentils should be included.

Good bowel habits and prevention of piles

Good bowel habits should be practiced. All at-risk individuals are advised to go to the bathroom as soon as they feel the urge.

Waiting may harden stools.

They are advised not to sit on the toilet for more than five minutes and avoid straining. If there is not urge the person is asked to get up.

Other ways to prevent piles

Other changes that may reduce the symptoms of piles include:

→ All people who are at risk need to take at least six to eight glasses of water daily to keep the stools lubricated.
→ Alcohol and caffeine containing drinks (tea, coffee and colas) should be avoided as these predispose to constipation.
→ Vigorous wiping especially with a dry toilet paper should be avoided as it irritates the skin around the anus.
→ Weight should be reduced since obesity and being overweight is a risk factor for piles.
→ Regular physical exercise is important since this helps in weight reduction and also helps in regular bowel movements and avoids constipation.
→ Stool softeners are medications that may be used in people with constipation to correct constipation before it can predispose to piles.
→ Some medications may lead to risk of constipation. These should be avoided. These include cough syrups with codeine.
→ Other conditions that predispose to piles include chronic cough, ascitis and liver disease. These conditions need treatment.

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