What are Piles? – Causes, Types, Diagnosis & Treatment

pilesPiles are a clinical condition where the blood vessels in the lower part of the rectum are swollen up. It is an extremely common condition that affects a large group of people all around the world.

Studies have estimated that nearly 10 to 12 million people in the United States suffer from piles. While in many cases, this condition go undiagnosed, when the patient does experience symptoms, they can be rather troublesome.

In this article we shall take an in-depth look into piles and how it can be treated effectively.

Causes of Piles

Before discussing the causes of piles, it is worthwhile understanding the normal structure of blood vessels and tissues in the lower part of the rectum. In brief, within the wall of the rectum are blood vessels, muscle tissue and other connective tissue which maintained the structure and function of the rectum.

Hemorrhoids (piles) are in fact enlarged blood vessels that are covered by the other tissues mentioned above.

There are a number of causes of piles –

1. Excessive straining – this is probably the most common cause as excessive straining can increase the pressure within the blood vessels and cause them to become enlarged.

Excessive straining occurs due to constipation and a diet that is low in fibre.

2. Pregnancy – the cause for piles in pregnancy is unclear but it may be related to increased pressure within the abdomen and possibly hormonal changes.

The condition only last for the duration of the pregnancy and seem to resolve spontaneously following delivery.

3. Bowel problems – piles have been associated with a long history of diarrhea and also sometimes seen in patients with cancer of the colon.

Patients who have undergone surgery to the lower part of the bowel and rectum are also more prone to developing piles. Other bowel diseases such as ulcerative colitis and Crohn’s disease seem to increase the risk as well.

4. Other causes – this condition seem to be more prevalent in patients who are obese. In addition, there seems to be some form of genetic involvement meaning it may run in families.


Types of hemorrhoidsThere are primarily two different kinds of piles. External piles (also called external hemorrhoids) are those that are visible outside the anal orifice while internal piles (also called internal hemorrhoids) are present within the rectal cavity.

The appearance between the two however is not the only difference and from a more anatomical point of view these two different types arise from different tissues and are supplied by different nerves.

It is this different nerves supply that causes pain with external hemorrhoids and no pain with internal hemorrhoids.

Clinical Features

One of the commonest complaints that patients present with to hospital or to the doctors clinic is symptoms related to the anal area. More often than not, patients tend to put this down to hemorrhoids but this is not always the case.

The symptoms of hemorrhoids are not unique to that condition. The common symptoms include pain around the anal area, itching, bleeding and sometimes prolapse of a small part of the hemorrhoids.

The doctor will usually take a detailed history particularly concentrating upon the risk factors that can lead to the development of piles. This may include a history of diarrhea, family history, the patient’s diet history and any other alteration in bowel habit.

The bleeding that can occur with piles can be rather troublesome and is usually the first symptom that patients complain of. Patients notice blood after wiping and it usually appears bright red.

The bleeding can irritate the surrounding area and cause itching. Sometimes, the blood within the piles can get clotted resulting in what is called a ‘thrombosed pile’. This can be rather painful and warrants early treatment.

Upon clinical examination, the doctor will make a note of the number of piles. This may require the patient to undergo a bedside test called digital rectal examination where a gloved finger is inserted into the anal passage to feel where the piles are.

In addition, the doctor will also assess whether there is any evidence of infection or the bleeding and symptoms are in fact due to another cause and not due to piles. On some occasions, a bedside camera test may be performed to get a better look.

Depending on the appearance of the internal piles, they can be divided into four grades. Grade 1 refers to small hemorrhoids present within the rectum that only bleed slightly while grade 4 hemorrhoids are larger hemorrhoids that protrude outside the anal orifice and maybe thrombosed.

In other words, grade 1 are mild while grade 4 are severe.


In most cases, the doctors can diagnose piles from a simple history and a clinical examination as described above. Blood tests may be performed to assess the hemoglobin levels to ensure that the patients have not lost too much blood from the hemorrhoids.

Other special tests include –

1. Clotting tests – This is a blood test to ensure that the blood clotting is normal and bleeding is not excessive due to problems with the blood.

2. Camera test – This is also called an anoscopy and flexible sigmoidoscopy. A thin tube with a camera at the end of it is passed through the anal orifice into the rectum and the structures there are visualized.

This can give an accurate estimate of the number of piles and also provide the doctor with an idea as to how to treat them.

Complications of piles

If piles are left untreated, they can become thrombosed and extremely painful. A thrombosed pile is one where the blood within it clots.The pain can be severe enough to affect normal activities to an extent where patients find trouble sitting down in one place for long periods of time.

Sometimes bleeding can be severe enough to make the patient anaemic and require treatment for that.


There are a number of different treatment options available. It is important as a patient to bear in mind that piles can actually be prevented by observing certain simple lifestyle changes.

Even if the piles are in the mild form, they can be prevented from getting any worse by observing these changes.

1. Lifestyle changes

Probably the number one piece of advice given to patients with piles is to adopt a high-fibre diet. If this is difficult to do, supplements such as ispaghulla are now available that bulk up the stools and allow for easy passage.

FruitsThis reduces the stress and strain required to open the bowels and therefore can prevent this from occurring or from worsening. Increasing fluid intake is also recommended.

Another important change that should be made is to lose weight if the patient is obese. This can be achieved by a strict diet plan along with plenty of exercise.

It is strongly recommended that the patient see a doctor before undertaking any such diet and exercise plans. Advice from a dietician will also be extremely useful.

Other lifestyle modifications include maintaining good anal hygiene and toilet retraining. Warm baths can also provide relief from pain and can relax the anal sphincter.

2. Medical treatment

In the cases of grade 1 piles or in patients who only have mild symptoms, painkillers can help reduce the pain. Sometimes, topical steroid creams maybe prescribed to help reduce the itching and inflammation.

3. Specialist treatments

In patients in whom the above measures are ineffective, certain specialist treatments are now available that is offered as long as there are no reasons why they should not be. These include the following –[list style=”checkmark”]

  • Rubber band ligation – in this procedure, a pipe rubber band is applied around the base of each individual pile thus cutting off its blood supply. Eventually the pile shrivels up and falls off.
  • Sclerotherapy – here’s a sclerosing agent is injected into the pile. This agent shrinks the pile and eventually this can falloff.
  • Coagulation therapy using electrocautery – in this procedure, infrared rays or a small amount of electricity is used to coagulate the blood within the piles and this help in their treatment.
  • Surgery – There are number of different surgical options that are available and a decision to conduct surgery is dependent on the treating physician and patient preference.New procedures have been developed though surgical procedures such as a haemorrhoidectomy are still considered as first-line as they have very good outcomes. Advanced treatments such as hemorrhoid artery ligation using a Doppler ultrasound probe seem to work very well too. A detailed discussion on each procedure is the scope of this article but it is well worth knowing that surgical options are available.[/list]

Prevention is Better Than Cure

It is important as a patient to bear in mind that hemorrhoids can be prevented or even treated early on by simple home-made remedies. By observing the lifestyle changes, the pain that accompanies piles can be avoided and complications will not occur.


Piles are a common condition that affects millions of people all over the world. Symptoms can be distressing and troublesome but treatment options are simple and effective.

Just changing one’s lifestyle can effectively prevent the symptoms from worsening and complications developing. Of course, advance surgical treatments are now available should there be any problems.


Image Credits: Types of hemorrhoids, by WikipedianProlific and Mikael Häggström, Wikimedia Commons

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