CONDITIONS

Haemorrhoids (Piles)

Symptoms, causes, treatments & when to seek help

Haemorrhoids (piles) are swollen blood vessels in and around the anus. They are very common and can cause bleeding, itching, discomfort, and sometimes a lump that comes down during bowel motions. Many cases improve with simple measures such as fibre, fluids and avoiding straining, but persistent or troublesome symptoms may need office procedures or surgery.

Symptoms Causes Self-care Procedures When urgent FAQs

What are haemorrhoids?

Haemorrhoids are enlarged vascular cushions that normally help with continence. When they become swollen or symptomatic, they may cause bleeding, itching, discomfort, or prolapse (a lump that comes down).

Important: Bleeding is often due to piles, but new rectal bleeding should not be ignored. Your GP may recommend assessment to rule out other causes.

HTML diagrams (simple guides)

These are simplified diagrams made with HTML/CSS (no SVG). They help explain where piles occur and how prolapse is described.

Internal vs external haemorrhoids

Internal: often painless bleeding; may prolapse

External: can be painful if thrombosed (clot)

Dentate line: helps explain why internal piles often bleed with less pain

Not to scale. Symptoms and treatment depend on internal/external location and severity.

Prolapse (how “grades” are often described)

Grade I

Bleeding without prolapse (no lump comes down)

Grade II

Prolapse comes down but goes back in on its own

Grade III

Prolapse needs to be pushed back in

Grade IV

Prolapse stays out (may be painful / swollen)

Grades are a guide and don’t replace an examination. Treatment is based on symptoms and findings.

Symptoms

Bright red bleeding (often on toilet paper or dripping into the toilet)
Itching and irritation
Discomfort or soreness around the anus
Lump that comes down during bowel motions (prolapse)
Mucus or soiling of underwear
Sudden severe pain with a lump can occur with a thrombosed external haemorrhoid

Get checked

New rectal bleeding, persistent change in bowel habit, unexplained weight loss, or ongoing symptoms should be discussed with your GP.

Common causes and triggers

Constipation and straining
Low fibre intake and inadequate fluids
Prolonged time on the toilet
Pregnancy and childbirth
Heavy lifting and chronic cough (increased pressure)
Diarrhoea (frequent wiping/irritation can worsen symptoms)

Self-care and home treatments

Main goal: keep stools soft and avoid straining — this helps most people.

What usually helps

Increase fibre gradually (fruit/veg, wholegrains, pulses) + adequate fluids
Consider a fibre supplement if diet alone isn’t enough
Use a stool softener/laxative short-term if constipated (pharmacist/GP advice)
Warm baths (sitz baths) for discomfort
Gentle hygiene; avoid over-wiping; consider barrier creams
Avoid prolonged sitting on the toilet; don’t strain

Over-the-counter creams/suppositories can ease symptoms short-term, but they don’t treat the underlying cause. If symptoms persist, get assessed.

Clinic treatments and procedures

If symptoms are troublesome or persistent despite self-care, treatments may include:

Rubber band ligation (banding) for suitable internal haemorrhoids
Injection therapy (sclerotherapy) in selected cases
Haemorrhoidectomy (surgical removal) for severe or recurrent cases
Stapled haemorrhoidopexy or other specialist techniques in appropriate patients

Thrombosed external haemorrhoid: early assessment matters — sometimes a small procedure can quickly relieve pain if done within a short timeframe.

When should I seek urgent help?

Seek urgent assessment if you have:

Heavy or persistent bleeding, dizziness or fainting
Severe anal pain with a new lump
Fever or severe pain with swelling (possible abscess)
Black/tarry stools or symptoms of significant blood loss

FAQs

Do haemorrhoids always cause bleeding?

No. Some cause itching, discomfort, or a prolapsing lump without bleeding. Others bleed without much pain. Any new bleeding should still be checked.

Is bleeding always “just piles”?

Not always. Piles are a common cause, but bleeding can also come from fissures, inflammation, polyps and (less commonly) cancer. If bleeding is new, persistent, or associated with bowel habit change, seek assessment.

What’s the best way to prevent piles coming back?

Prevent constipation and straining: gradual fibre increase, adequate fluids, regular activity, and avoiding prolonged time on the toilet are the most helpful long-term steps.

Are creams and suppositories safe to use?

Many over-the-counter options are safe short-term, but they shouldn’t be used for long periods without advice. If symptoms persist, the diagnosis should be confirmed and other treatments considered.

When do piles need surgery?

Surgery is usually considered for severe prolapse, recurrent symptoms, or when other treatments (like banding) aren’t suitable or haven’t helped. Your surgeon will discuss the best option based on your symptoms and examination.