Piles (Haemorrhoid) 101: Symptoms, Causes, Types, Treatment, Medicine & Home Remedies

What Are Piles or Haemorrhoids?

Piles, also known as haemorrhoids, are swollen blood vessels that develop inside the rectum, which is the part of the body connecting to the bottom, or under the skin surrounding the anus, which is the bottom hole in the body where we excrete waste. Piles are a common medical condition, with three out of four adults getting piles at least once in their lifetime. After the age of 30, this condition is usually more common, with  about 50% of people over the age of 50 exhibiting symptoms of piles. Piles can be accompanied with pain, discomfort, and an itchy sensation around the bottom. They are one of the top causes of rectal and anal bleeding, but they usually disappear without any need for further treatment. However, some cases of piles may require surgery or further medical treatment options, or diet and lifestyle modifications to treat the condition. 

Piles can have a range of sizes, and can be found inside the anus or outside. These are known as internal and external piles. 

Types of Piles

Internal Haemorrhoid (Piles)

Internal piles develop within the anus, and are normally located between 2 and 4 centimeters (cm) above the opening of the anus. It is usually accompanied by blood-covered stool after passing motion. Although bleeding is painless, internal piles can become irritated and painful when they protrude out of the anus. Internal piles are the more common variant of piles.

External Haemorrhoid (Piles)

External piles occur near the anus, on the outside edge of the anus. It is covered by very sensitive skin, and is often recognised as a painful swelling or hard lump around the anus. It is usually visible. 

What Causes Piles?

Piles are believed to be caused by excess pressure against the blood vessels in the region of the anus and rectum. These blood vessels help the body with controlling bowel movements.  During a bowel movement, some people may repeatedly strain and push to help with easing the movement. This can result in the blood vessels in the anus being squeezed too tightly, resulting in a higher blood pressure in the region. This can cause the vessel to swell up with blood. The wall of this blood vessel is then stretched out due to the swelling, which may result in the vessel breaking or tearing easily, causing bleeding. 

Repetitive straining also causes supporting ligaments in the blood vessel to become overstretched and lose their elasticity. When the blood vessel loses its elasticity,  it descends further down the anal canal and eventually protrudes outside the anus. Once it extends outside of the body and bulges out of the rectum, it becomes a prolapsed haemorrhoid. Both internal and external piles can become prolapsed haemorrhoids. 

Some factors which contribute to the cause of piles include: 

• Age
• Having anal intercourse
• Obesity
• Chronic diarrhea or constipation 
• Lifting heavy weights 
• Pregnancy
• Individuals leading a sedentary lifestyle 
• Individuals with bad stool habits, such as reading in the bathroom or spending a long time on the toilet 

Piles Stages

Piles can be classified into several stages: 

Grade 1

Grade 1 piles refer to internal piles which are inside the lining of the anus. No apparent signs of piles are present at this stage.

Grade 2

At this stage, these piles are larger than Grade 1 piles, but still remain inside the lining of the anus. They may be pushed out during passing stools, but will retract back into the body. 

Grade 3

These piles slip out of the anus and are visible from the outside. They are known as prolapsed haemorrhoids, and can be felt hanging out of the anus. They can be placed back inside the body. 

Grade 4

The piles at Grade 4 hang out from the opening of the rectum and cannot return to the body by itself. They are large and require treatment. 

Piles Symptoms

An individual with piles may experience the following symptoms:

• A sensation that the bowels are still full after passing motion
• Slimy mucus on toilet paper after wiping the bottom or on underwear 
• Bright red blood visible after a bowel movement, or red stains on toilet paper after wiping
• The area around the anus experiences itchiness, redness, and soreness
• During passing of a stool, pain occurs
• A hard and painful lump, usually containing coagulated blood, may be felt around the anus

Symptoms are usually not serious and often resolve by themselves within a few days. However, piles can escalate into a more serious situation, including some of the below conditions: 

• Excessive anal bleeding which could lead to anaemia (a lack of healthy red blood cells)
• Infections
• Inability to control bowel movements, otherwise known as faecal incontinence
• A fistula in the anal region, which abnormally connects the surface of the skin near the anus and the inside of the anus
• A strangulated hemorrhoid, in which the blood supply to the pile is cut off, causing complications including infection or a blood clot

Diagnosing Piles

A doctor can make the diagnosis of piles after a physical examination with the patient. They will examine the anus of the person with suspected piles. The doctor may ask the following questions to find out more case history first: 

• Are there any family members who have a known history of piles? 
• What colour are the person’s stools? 
• Has there been any recent and sudden weight loss? 
• Has there been a significant change in bowel movements recently?
• Was there any blood or mucus spotted in the stools? 

For different types of piles, the doctor will use different methods of examination. For internal piles, the doctor may need to use special tubes to help them see the inside of the anus. There are several types of special tubes which may be used, such as anoscopes, proctosopes, or sigmoidscopes. These are inserted up into the anus after being coated with a substance to lubricate the device and help ease entry into the anus. The doctor may then take a small tissue sample from inside the rectum, and send it to a lab for analysis. 

A colonoscopy may be recommended if the person with piles presents with signs and symptoms that may suggest another digestive system disease, or if they appear to be at risk of having colorectal cancer. 

Piles Treatment

Majority of piles cases resolve by themselves without the need for further treatment. 

Piles treatment usually starts from lifestyle changes. If this does not help and the symptoms of piles further persist, further treatment options including surgery can be considered. Treatment can also be considered in helping to significantly reduce any discomfort and itching accompanying piles.

Home Remedies for Piles

Lifestyle changes may be recommended by the doctor to treat piles, such as:

Eating a diet rich in fibre

Piles can occur due to straining during bowel movements, and excessive straining could be the result of constipation or hard stools. To keep stool soft and easy to pass through, a change in diet could help. Some high fibre foods include fruits and vegetables, or bran-based breakfast cereals. 

Drinking more fluids

Drinking more fluids helps to decrease straining during passing motion, so that the pressure on the piles is reduced and prevents them from bleeding or protruding out of the anus. 

Exercising

This is one of the main ways to help with piles. It is also advised to avoid straining during weight lifting. 

Avoiding caffeinated drinks

In line with drinking more fluids, caffeinated drinks can cause dehydration. 

Losing excess body weight

Losing weight may help to reduce the occurrence and severity of piles, especially if the person is obese. 

There are also several medicines available to help people with piles manage the symptoms: 

Over-the-counter (OTC) medications

These are available over-the counter or online. A prescription from the doctor is needed to access these medications. These medications include painkillers, ointments, creams, and pads. They can assist with relief of piles symptoms, and help in soothing redness and swelling around the anus. It is important to note that OTC medications do not cure piles. Do seek the correct dosage and types of medications from a doctor first, before purchasing medication, as some medicines are not to be mixed together for use. Also, it is advisable not to use OTC medications for more than seven days in a row, as these medications can cause further irritation to the area and cause the skin to thin. 

Corticosteroids

These help to reduce inflammation and pain.

Laxatives

If the person with piles suffer from constipation, the doctor may also prescribe laxatives to aid with the passing of stool. This reduces pressure on the lower colon and eases the symptoms of piles. 

If lifestyle changes do not help with alleviating the symptoms of piles, further treatment options can be considered, and these include non-surgical treatments and surgical options. 

Treatment Options for Piles 

If there is no improvement to the person’s piles after home treatments, further medical treatment options may be needed. Treatment does not necessarily prevent piles from recurring again, so it is important to speak with the doctor for the best personalised treatment option.

Non-surgical treatment options for piles

Commonly used treatment options for piles are:

Ligation

Otherwise known as rubber band ligation, this option works best for internal piles that protrude with bowel movements. A rubber band is placed over the pile to cut off its blood supply, causing it to fall off. The wound usually heals in one to two weeks, and does not require hospitalisation. 

Sclerotherapy injection

This method is relatively painless, and can be used on bleeding piles that do not protrude. A liquid is injected into the piles, causing them to shrivel up and shrink. Hospitalisation is also not required for this procedure.

If these treatments do not work, surgery may be required to remove the piles. 

Surgical treatment options for piles 

The surgical options for piles include: 

1. Haemorrhoidectomy

It is currently the best method for permanent removal of piles. This procedure removes excess tissue which causes bleeding and protrusion of the pile from the anus. This surgical option is considered when

• Blood clots repeatedly form in external piles
• Ligation fails to treat internal piles 
• The protruding piles cannot be reduced
• Persistent bleeding of the piles are observed.

It is done under anesthesia and requires hospitalisation. 

2. Stapled haemorrhoidectomy

This procedure uses a specialised circular stapler to remove the piles. Stapled haemorrhoidectomy is particularly useful for larger-sized piles, and a better outcome is usually achieved with the removal of the piles. Advantages of this procedure is that it is not as painful as the other procedures, and it can be done as a  day surgery.

Understand how Medisave may help with costs of surgery here. 

When Should I See a Doctor for Piles?

If bleeding during bowel movements is observed, or if piles do not improve after a week of home remedies, do consult a doctor for further medical advice. 

Sometimes, bleeding in the rectum and anus could be a cause for other medical issues, such as cancer. Do observe if the person’s bowel habits have changed or if the appearance of their stools have changed in colour or consistency. 

If large amounts of bleeding from the anus is observed, and the person feels lightheaded, dizzy, or faint, seek emergency care immediately.

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