Piles (haemorrhoids)

Piles, also known as haemorrhoids, are swollen veins and muscle around your anus or in your anal canal.

Your anal canal is a short, muscular tube with blood vessels that connects your rectum (back passage) with your anus. Piles can develop when this tissue becomes swollen, possibly as a result of straining on the toilet. Sometimes, piles can be painful and bleed if they become damaged.

Internal piles start inside your anal canal, but they might hang down and so come out your anus. Internal piles can be graded according to whether they come out your anus 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 bowel movement, but go back inside on their own afterwards.
• Third degree piles come out of your anus and only go back inside when you push them in.
• Fourth degree piles are always partly outside your anus and you can’t push them back in. They may 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 very painful, especially if they have a blood clot in them.

Your GP will ask about your symptoms and examine you. He or she will feel your rectum by gently inserting a gloved finger into your anus. Your GP may also use a proctoscope to look inside your rectum. A proctoscope is a short, narrow, tube-like instrument. There are a few different types of proctoscope – some of them have their own light source whereas others don’t. You might find the procedure uncomfortable.

Your GP may also ask you to have a blood test to check if you have anaemia. This is a low number of red blood cells in your blood. Anaemia can be a sign that you have a more serious condition.

If your test results suggest your symptoms might be caused by something else, your GP may refer you to hospital for more tests. These can rule out other conditions, such as cancer.

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