- Grade 1 are small swellings on the inside lining of the anal canal. They cannot be seen or felt from outside the opening of the back passage (anus). Grade 1 piles are common. In some people they enlarge further to grade 2 or more.
- Grade 2 are larger. They may be partly pushed out from the anus when you go to the toilet, but quickly spring back inside again.
- Grade 3 hang out from the anus when you go to the toilet. You may feel one or more as small, soft lumps that hang from the anus. However, you can push them back inside the anus with a finger.
- Grade 4 permanently hang down from within the anus, and you cannot push them back inside. They sometimes become quite large.
Sometimes there are no symptoms and may not realise that you have any piles.
The most common symptom is bleeding after going to the toilet to pass stools (faeces). The blood is usually bright red and may be noticed on the toilet tissue, in the toilet pan or coating the stools.
A pile can hang down (prolapse) and can be felt outside the back passage. Often, it can be pushed back up after you have been to the toilet. However, more severe piles remain permanently prolapsed and cannot be pushed back up inside.
Small internal piles are usually painless. Larger piles may cause a mucous discharge, some pain, irritation and itch. The discharge may irritate the skin around the anus. You may have a sense of fullness in the anus, or a feeling of not fully emptying your back passage when you go to the toilet.
What are the complications of piles?
A possible complication of piles that hang down is that they can 'strangulate'. This means that the blood supply to the pile has been cut off. A blood clot (thrombosis) can form within the pile. This causes really severe pain if it occurs. The pain usually reaches a peak after 48-72 hours and then gradually goes away over 7-10 days.
Further reading and references
Haemorrhoids; NICE CKS, July 2016 (UK access only)
Haemorrhoidal artery ligation; NICE Interventional Procedure Guidance, May 2010
Stapled haemorrhoidopexy for the treatment of haemorrhoids; NICE Technology Appraisal Guidance, September 2007
Electrotherapy for the treatment of haemorrhoids; NICE Interventional Procedure Guidance, June 2015
Hardy A, Cohen CR; The acute management of haemorrhoids. Ann R Coll Surg Engl. 2014 Oct96(7):508-11. doi: 10.1308/003588414X13946184900967.
Hi everyone! Thank you everyone for sharing your experience as they helped me getting through this recovery tremendously! Every body is a little different, reaction to the traumatic surgery, pain...Gettingbetter2
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