Hemorrhoids or piles are swollen veins around the anal opening. They can be very painful and linger on for a long time causing distress. The main symptoms include bleeding during the bowel movement and itching. Although hemorrhoids are thought of as unpleasant inflammations. It is when the hemorrhoidal cushions become too big .i.e inflamed that problems occur, when this happens they are called piles or pathological hemorrhoids.
Piles can be of various sizes and may be internal (inside the anus) or external ones (outside the anus). Typically, internal piles occur from 2 to 4cm above the opening of the anus. External piles (perianal hematoma) occur on the outside edge of the anus. The internal ones are much more common


Internal hemorrhoids are classified into four grades:

Grade 1 - there are small inflammations, usually inside the lining of the anus. They are not visible
Grade 2 - larger than grade 1 hemorrhoids, but also inside the anus. When passing a stool, they may get pushed out, but return unaided
Grade 3 - often called 'prolapsed hemorrhoids'; these appear outside the anus. The patient may feel them hanging out. They can be pushed back in if the patient presses with their finger
Grade 4 - these cannot be pushed back in and need to be treated by a doctor. They are large and stay outside the anus all the time.

External hemorrhoids are are small lumps that are located on the outside edge of the anus. They are very itchy and can be painful if a blood clot forms inside (thrombosed external hemorrhoid). Thrombosed external hemorrhoid requires medical treatment straight away.

Symptoms of piles
An individual with piles may experience the following symptoms:

A painful hard lump may be felt around the anus.
After going to the toilet, a feeling that the bowels are still full
Bright red blood after a bowel movement
Itchiness around the anus
Mucus discharge when emptying the bowels
Pain while defecating
The area around the anus may be red and sore.

You may be wondering, why do piles occur?
The blood vessels around the anus and in the rectum will stretch under pressure and may swell or bulge. Inflamed veins (hemorrhoids) can develop when pressure increases in the lower rectum. This may be due to:
Chronic constipation
Chronic diarrhea
Lifting heavy weights
Pregnancy
Straining when passing a stool.
The tendency to develop hemorrhoids may also be inherited.
The risk of developing piles grows with age.

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