PILES (HHaemorrhoidsaemorrhoids) are swellings that can occur inside and around the back passage (anus) and the anal canal.

The anal canal is the last part of the large intestine and is about 4 cm long. At the lower end of the anal canal is the opening to the outside (usually referred to as the anus), through which faeces pass. At the upper end, the anal canal connects with the rectum (also part of the large intestine).

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 small swellings called piles.

What are the different types of piles (haemorrhoids)?

Internal piles (haemorrhoids) are those that form above a point 2-3 cm inside the back passage (anus) in the upper part of the anal canal. Internal piles are usually painless because the upper anal canal has no pain nerve fibres. External piles are those that form below that point, in the lower part of the anal canal. External piles may be painful because the lower part of the anal canal has lots of pain nerve fibres.

Symptoms can vary. Sometimes no symptoms may be present and a person may not realise that they have piles (haemorrhoids).

The most common symptom experienced 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 haemorrhoid can hang down (prolapse) and can be felt outside the anus. 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 back passage (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.

A possible complication of piles that hang down is that they can 'strangulate' (the blood supply to the haemorrhoid can be cut off). This can be intensely painful. Another possible complication is a blood clot (thrombosis) which can form within the haemorrhoid. This is uncommon, but again causes intense pain if it occurs. The pain usually peaks after 48-72 hours, and then gradually goes away over 7-10 days.


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