What are piles?
Haemorrhoids are normal cushions inside the anal canal. They cause symptoms when enlarged, inflamed, clotted or prolapsing. Internal piles commonly cause bright red bleeding or tissue that comes out during a bowel movement. A clotted external pile can cause a sudden painful lump.
Fissure, fistula, polyps, bowel inflammation and cancer can cause similar symptoms, which is why examination matters.
What are the symptoms of piles?
Common symptoms are:
- Painless bright red blood on the toilet paper, in the pan or on the stool
- Tissue that comes out during a bowel movement and may need to be pushed back
- Itching, irritation or mucus around the anus
- A sudden painful, tense lump at the anal edge (a clotted external pile)
Fissure, fistula, polyps, bowel inflammation and cancer can cause similar symptoms, so bleeding should be examined rather than assumed to be piles.
How are piles diagnosed?
The surgeon asks about bleeding, pain, prolapse, bowel habit, medicines and family history. Inspection, a gentle rectal examination and anoscopy usually identify the source. Colonoscopy is advised selectively according to age, anaemia, bowel symptoms, family history or doubt about the bleeding source.
Grading describes how far internal piles prolapse, but the external component and effect on daily life also guide treatment.
When do piles need a procedure?
Fibre, fluids, warm sitz baths and avoiding straining help at every stage, before and after treatment. Persistent grade I or II and selected grade III internal piles often respond to an outpatient procedure, most commonly rubber-band ligation.
Surgery is considered for a large external component, combined grade III or IV prolapse, repeated bleeding, failure of clinic treatment or a painful clot in selected early cases.
How are piles treated, and what are the risks?
Two operations are offered, matched to the grade and type of piles: Stapled Haemorrhoidectomy and Open Haemorrhoidectomy.
Stapled haemorrhoidectomy (also called stapled haemorrhoidopexy) uses a circular stapling device to remove a ring of tissue above the piles and lift them back into place. It is used for internal piles that come out (prolapse). Open haemorrhoidectomy removes large external piles, or piles with hard or scarred tissue. Risks include pain, bleeding, difficulty passing urine, infection and piles coming back.
Recovery after piles treatment
Keep stools soft from the first day and use prescribed pain relief. Sit in a warm sitz bath (a tub of plain warm water) for 10–15 minutes, 2–3 times a day and after passing stool. Most people return to desk work in 5–7 days after stapled surgery and in 1–2 weeks after open surgery.
When to seek urgent care
Seek prompt assessment for heavy or repeated bleeding, dizziness, faintness, black stools, severe pain with fever, a rapidly enlarging lump, unexplained weight loss or a change in bowel habit. Do not assume that rectal bleeding is caused by piles.