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 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.

What are the symptoms of piles?
Symptoms can vary depending on the size, position and grade of the pile.

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.
Haemorrhoids (piles)
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.

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