Piles (haemorrhoids) are swellings that develop inside and around the back passage (anal canal). There is a network of small veins (blood vessels) within the lining of the anal canal. These veins sometimes become wider and engorged with more blood than usual. The engorged veins and the overlying tissue may then form into one or more swellings (piles).
Piles are very common but not something you'll want to talk to your friends about. We don't know precisely how common piles are because many piles are small and not seen by a doctor. Piles often don't cause any problems but can cause bleeding and sometimes pain. If they do cause any bleeding or pain then you should see a doctor.
What different types are there?
Piles can be divided into either internal or external piles. Some people develop internal and external piles at the same time.
- Internal piles are deeper and initially form above a point 2-3 cm inside the back passage (anal canal) in the upper part of the anal canal.
- External piles start off nearer the surface, below a point 2-3 cm inside the back passage.
Despite the name, external piles aren't always seen outside of the opening of the back passage (anus). Equally confusing, internal piles can enlarge and drop down (prolapse), so that they hang outside of the anus.
Piles are also graded by their size and severity.
Do I need any tests?
If you think that you may have piles, or have bleeding or pain from your back passage (anal canal), you should visit your doctor.
Piles are usually diagnosed after your doctor asks you questions about your symptoms and performs a physical examination. The examination usually includes an examination of your back passage. Wearing gloves and using a lubricant, your doctor will examine your back passage with their finger to look for any signs of piles or other abnormalities.
Your doctor may suggest a further examination called a proctoscopy. In this procedure, the inside of your back passage is examined using an instrument called a proctoscope. You may be referred to a specialist for more detailed bowel examination (colonoscopy) to help rule out other conditions.
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.
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