Piles (haemorrhoids) are enlarged blood vessels that you can get inside or around your anus (the opening of your bottom). It’s completely normal to have blood vessels in your anus, as they play an important role in continence. But piles can develop if these blood vessels become enlarged, which can cause symptoms.

Your anus is lined with spongy tissue supplied with blood vessels – the anal cushions – and they help your anus to close. These are perfectly normal but sometimes they can develop into piles. Piles usually look like small, round, discoloured lumps. You might be able to feel them on your anus or hanging down from your anal canal. Your anal canal is the short, muscular tube with blood vessels that connects your rectum (back passage) with your anus.

Types of piles
Internal piles start inside your anal canal, but they might hang down and come out your anus. They’re graded according to whether they come out, 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 poo, but go back inside on their own afterwards.
Third degree piles come out of your anus and only go back inside if you physically push them back in.
Fourth degree piles always hang down from your anus and you can’t push them back in. They can 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 really painful, especially if they have a blood clot in them.

It’s possible to have both internal and external piles at the same time.

Causes of pile
Piles develop when the veins in your anal canal become swollen, which may happen for a number of reasons, such as:

if you strain when you go to the toilet, for example if you have constipation or long-lasting diarrhoea
getting older – your anal canal weakens with age, which makes piles more likely
having a persistent cough
lifting heavy objects

Piles are also common during pregnancy. They may develop due to the higher pressure in your tummy (abdomen) when you’re pregnant. They usually get better after you give birth.

Some people believe there’s a link between stress and piles but there’s no evidence to support this. But having piles can be potentially stressful.

Another theory is that you’re more likely to get piles around the time of your period. But there’s currently no evidence to support this.

If you have piles, it can be uncomfortable, and it’s understandable if they make you feel a bit self-conscious. They might have an effect on other areas of your life, such as your sex life if your piles hang out or you have some discharge.


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