Haemorrhoids, commonly called piles, are swollen blood vessels in and around the anus and lower rectum. They are very common, especially in adults over 45 and during pregnancy. Piles can cause bright red bleeding, itching, discomfort and a lump around the anus. Most get better on their own or with simple treatment. Because rectal bleeding can also have more serious causes, it should always be checked by a health worker.
Key facts
- Straining on the toilet because of constipation is the most common cause.
- Bright red blood on the tissue or in the toilet is a typical sign.
- More fibre and water, and not straining, help most piles heal.
- Piles are not caused by eating pepper or sitting on hot surfaces, though these may irritate symptoms.
- Rectal bleeding should always be checked, especially if you are over 40.
Types of piles
- Internal piles: inside the rectum. Usually painless but can bleed or bulge out (prolapse) during bowel movements.
- External piles: under the skin around the anus. Can be itchy or painful.
- Thrombosed piles: external piles with a blood clot, causing a sudden, very painful purple or dark lump.
Causes and risk factors
- Constipation and straining
- A low-fibre diet
- Sitting on the toilet for long periods
- Chronic diarrhoea
- Pregnancy and childbirth
- Being overweight
- Heavy lifting
- Ageing
Symptoms
- Bright red blood after passing stool
- Itching or irritation around the anus
- A lump around or hanging outside the anus
- Pain or discomfort, especially when sitting
- Mucus in underwear or on tissue
- A feeling of not fully emptying the bowels
Self-help
- Eat more fibre: beans, vegetables, fruit, oats and whole grains. Increase slowly to avoid bloating.
- Drink plenty of water to keep stools soft.
- Do not strain, and do not sit on the toilet for long periods or while using your phone.
- Go when you feel the urge; do not hold it in.
- Stay active.
- Soak in a warm bath or sitz bath for 10 to 15 minutes to ease pain and itching.
- Keep the area clean and dry, and pat rather than rub.
Treatment
- Pharmacy creams, ointments and suppositories to ease swelling, itching and pain. Use steroid-containing products for no more than a week unless advised.
- Stool softeners or fibre supplements for constipation.
- Paracetamol for pain. Avoid codeine-containing painkillers, which cause constipation.
- Procedures for piles that do not improve: rubber band ligation, injections, or heat treatment, usually done in a clinic.
- Surgery (haemorrhoidectomy or stapling) for large or persistent piles.
Be cautious of herbal “pile cures” and unregistered medicines. Some contain strong steroids or harsh substances that damage the skin.
Could it be something else?
Bleeding from the back passage can also be caused by anal fissures, bowel inflammation, polyps or bowel cancer. See a health worker, especially if you have dark blood mixed with stool, a change in bowel habit lasting more than three weeks, weight loss or tiredness. See our cancer guide for warning signs.
When to see a doctor
See a doctor if you have bleeding from the back passage, symptoms that do not improve after a week of self-care, or piles that keep coming back. Seek urgent care for heavy bleeding, bleeding with dizziness or fainting, black tarry stools, or severe pain with fever.
Frequently asked questions
Do piles turn into cancer?
No. But bowel cancer can cause similar symptoms, which is why bleeding should be checked.
Are piles common in pregnancy?
Yes, because of hormones, constipation and pressure from the growing baby. They usually improve after birth. Ask your antenatal clinic before using any cream.
Related guides
Sources
- NHS: Piles (haemorrhoids)
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH): Hemorrhoids
