Haemorrhoids (piles) are enlarged blood vessels that you can get inside or around your anus (the opening of your bottom). It’s completely normal to have blood vessels in your anus, as they play an important role in continence. But piles can develop if these blood vessels become enlarged, which can cause symptoms.
Your anus is lined with spongy tissue supplied with blood vessels – the anal cushions – and they help your anus to close. These are perfectly normal but sometimes they can develop into piles. Haemorrhoids usually look like small, round, discoloured lumps. You might be able to feel them on your anus or hanging down from your anal canal. Your anal canal is the short, muscular tube with blood vessels that connects your rectum (back passage) with your anus.
Types of piles
Internal piles start inside your anal canal, but they might hang down and come out your anus. They’re graded according to whether they come out, and if so, how far they come out.
- First degree piles may bleed but don’t come out of your anus.
- Second degree piles come out of your anus when you have a poo, but go back inside on their own afterwards.
- Third degree piles come out of your anus and only go back inside if you physically push them back in.
- Fourth degree piles always hang down from your anus and you can’t push them back in. They can become very swollen and painful if the blood inside them clots.
External piles are swellings that develop further down your anal canal, closer to your anus. They can be really painful, especially if they have a blood clot in them.
It’s possible to have both internal and external piles at the same time.
Causes of piles
Piles develop when the veins in your anal canal become swollen, which may happen for a number of reasons, such as:
- if you strain when you go to the toilet, for example if you have constipationor long-lasting diarrhoea
- getting older – your anal canal weakens with age, which makes piles more likely
- having a persistent cough
- lifting heavy objects
Piles are also common during pregnancy. They may develop due to the higher pressure in your tummy (abdomen) when you’re pregnant. They usually get better after you give birth.
Some people believe there’s a link between stress and piles but there’s no evidence to support this. But having piles can be potentially stressful.
Another theory is that you’re more likely to get piles around the time of your period. But there’s currently no evidence to support this.
Symptoms of piles
Piles don’t always cause pain or other symptoms, but if you do have symptoms, they might include:
- bleeding when you poo – you may see blood (usually bright red) on toilet paper or drips in the toilet or on the surface of your poo
- a lump in or around your anus
- a slimy discharge of mucus from your anus, which may stain your underwear
- a feeling of ‘fullness’ and discomfort in your anus, or a feeling that your bowels haven’t completely emptied after you’ve gone to the toilet
- itchy or sore skin around your anus
- pain and discomfort after you go to the toilet
These symptoms can vary a lot between individuals. They may also be caused by problems other than piles, such as inflammatory bowel disease, anal cancer, bowel cancer and an anal fissure (tear). So, if you have any of these symptoms, contact your GP for advice – don’t just assume they’re caused by haemorrhoids.
Self-help for piles
If you make a few changes to your diet and lifestyle it can help with the symptoms of piles.
- Eat a high-fibre dietto help make your poo softer and easier to pass. This will help to reduce the pressure on the veins in your anus caused by straining when you have a poo.
- Drink enough fluids to keep hydratedbut don’t have too much caffeinated ones like tea and coffee.
- Keep active and exercise each day. There might be some activities that you may find difficult if you have external piles, such as cycling. You might find it helpful to use a cushioned seat pad if this is the case. Or, you may want to switch to something else for a while until your symptoms get better. Generally, though, physical activity is good for your healthand shouldn’t make your haemorrhoids worse.
- Try not to strain when you go to the toilet. Afterwards, gently clean around your anus with water and pat the area dry.
You won’t need to cut things out of your diet unless your doctor advises you to.
Prevention of piles
If you eat a healthy diet and lead a healthy lifestyle, it can help to keep your poo soft and prevent constipation, which will help to prevent piles.
- Eat plenty of fibre-rich foods.
- Drink plenty of fluids but limit the caffeinated ones, such as tea and coffee.
- Exercise regularly.