Piles (Babasir in English) - Types, Symptoms, Causes & Complications

What is Piles?

Piles, medically known as hemorrhoids, are enlarged and swollen blood vessels that develop in and around the anus and lower rectum. These blood vessels become stretched and irritated when one strains during bowel movements or due to increased pressure in the pelvic area. 

The condition affects the hemorrhoidal cushions, which are a normal anatomy of the anal region that assist in regulating bowel movements. When these cushions swell as a result of a number of factors, then the symptoms of hemorrhoids occur. The condition is divided into two broad categories according to their location, and severity is graded into I-IV according to the degree of prolapse and the symptoms.

Types of Piles

Hemorrhoids are classified based on their location relative to the anal canal and rectum. This categorization helps physicians identify the best treatments for piles and forecasting the symptoms that patients are likely to encounter. Because internal and external piles react differently to different treatments, the location affects both the symptoms and the treatment strategy.

1. Internal Piles

• Location: Inside the rectum, above the anal opening, covered by a mucous membrane that lacks pain receptors
• Pain: Usually painless due to the lack of pain receptors in this area, making them often go unnoticed initially
• Bleeding: May cause bleeding during bowel movements, often bright red blood that appears on toilet paper or in the bowl
• Visibility: Not visible or felt externally unless they prolapse outside the anal opening during bowel movements

2. External Piles

• Location: Under the skin around the anus, below the anal opening, covered by sensitive skin tissue
• Pain: Often painful and tender, especially when sitting, walking, or during bowel movements, due to a rich nerve supply
• Swelling: Can form visible lumps or bumps around the anal area that may be blue or purple in colour
• Discomfort: May cause intense itching, irritation, or burning sensations that worsen with friction from clothing

Grade Classification of Piles

Internal piles are further classified into four grades based on their degree of prolapse (bulging outside the anus) and how easily they return to their original position. This grading helps doctors determine whether you  require non-surgical or surgical treatment. 

• Grade I – These are small swellings that stay inside the rectum and do not protrude outside. Bleeding during bowel movements may be the only symptom. Often managed with lifestyle changes and medication. 
• Grade II – These piles prolapse (bulge out) during straining or bowel movements but retract back inside on their own. Symptoms may include bleeding, mild discomfort, and a feeling of incomplete evacuation. 
• Grade III – Prolapse occurs during bowel movements and does not retract on its own. Manual pushing is required to return them inside. Symptoms often include bleeding, pain, and discomfort during sitting or movement. Minimally invasive procedures are commonly used at this stage. 
• Grade IV – These piles remain permanently prolapsed outside the anus and cannot be pushed back in. They may cause continuous pain, swelling, and risk of clot formation or infection. Surgical intervention is usually necessary for relief.

Note: Grade classification does not apply to external piles, as they are always visible and doctors assess them on the basis of symptoms like pain, swelling, or clotting rather than prolapse.

Pile Symptoms

Pile symptoms can range from mild discomfort to severe pain, depending on the type and grade of hemorrhoids. Symptoms may develop gradually over time or appear suddenly, particularly when blood clots form in external hemorrhoids. The severity and combination of symptoms help doctors decide the right mode of piles treatment. 

Common piles symptoms include:

• Painless bleeding: Bright red blood on toilet paper, in the toilet bowl, or on the stool surface after bowel movements, typically from internal hemorrhoids 
• Itching and irritation: Persistent itching around the anal area caused by mucus discharge or skin irritation from swollen tissue 
• Pain or discomfort: Especially when sitting, walking, or during bowel movements, more common with external piles or thrombosed hemorrhoids 
• Swelling or lumps: Tender lumps near the anus that may be felt during cleaning or when sitting. Lumps can be soft or hard depending on the contents 
• Mucus discharge: Clear or slightly colored discharge from the anus that can stain underwear and cause skin irritation 
• Feeling of incomplete evacuation: Sensation that bowel movement is not complete, even after successful defecation 
• Anal leakage: Small amounts of feces may leak involuntarily due to  the inability to completely close the anal opening

Piles Causes

Learning about hemorrhoids helps in prevention and treatment planning. The primary cause involves increased pressure on the veins in the pelvic and rectal area, which causes them to swell and become inflamed. This pressure can result from both physical factors and lifestyle habits that affect bowel movements and circulation.

The major causes of piles are:

• Chronic constipation: Straining during hard bowel movements increases pressure in rectal veins and weakens supporting tissues over time 
• Chronic diarrhea: Frequent loose stools can irritate anal tissues and cause inflammation that leads to hemorrhoid development 
• Prolonged sitting: Sitting for long periods, especially on the toilet while reading or using phones, increases pressure on the anal veins 
• Heavy lifting: Regularly lifting heavy objects increases abdominal pressure, which transmits to the pelvic veins and can cause swelling 
• Obesity: Excess weight puts additional pressure on pelvic veins and increases the risk of developing hemorrhoids 
• Pregnancy: A growing uterus increases pressure on pelvic blood vessels, and hormonal changes soften vein walls, making them more prone to swelling 
• Low-fiber diet: Lack of fiber leads to harder stools that require more straining, increasing pressure during bowel movements 
• Aging: Tissues supporting rectal veins weaken with age, making older adults more susceptible to hemorrhoid development

When to See a Doctor

Seeking medical attention promptly prevents hemorrhoids from worsening and helps identify any serious underlying conditions. Many people delay consultation due to embarrassment, but early treatment provides better outcomes with less invasive procedures. Doctors who specialize in treating hemorrhoids include gastroenterologists, colorectal surgeons, and proctologists who have extensive experience in managing this condition.

See a doctor if any of the following symptoms occur:

• Persistent rectal bleeding continuing for more than a few days
• Constant or severe pain that interferes with daily activities
• No relief from home remedies for piles even after one week
• Lumps that remain after passing stool or increase in size over time
• Unexplained blood in stool accompanied by changes in bowel habits

Risk Factors

Some individuals are more likely to develop hemorrhoids based on demographic, genetic, and lifestyle factors. Age is the most significant risk factor for piles, with the condition becoming more common after age 45.

How are Piles Diagnosed?

Proper diagnosis of piles requires medical examination by a proctologistor gastroenterologist. The diagnosis process involves reviewing symptoms, medical history, and physical examinations to determine the type and severity of hemorrhoids. Accurate diagnosis is essential because other conditions like anal fissures, inflammatory bowel disease, or colorectal cancer can cause similar symptoms. 

Most diagnoses can be made through:

• Visual examination: The doctor examines the anal area for external piles, looking for swelling, discoloration, or visible hemorrhoids 
• Digital rectal examination: The doctor inserts a gloved, lubricated finger to feel for internal piles and assess their size and location 
• Anoscopy: A small, short tube is inserted a few inches into the anal canal to view the lower rectum and internal hemorrhoids 
• Proctoscopy: Doctor uses a longer tube to examine the entire rectum for hemorrhoids and other abnormalities 
• Sigmoidoscopy: A flexible tube is used to examine the lower portion of the colon if the bleeding source needs clarification 
• Colonoscopy: Complete colon examination recommended if the patient has risk factors for colorectal cancer or unexplained bleeding

Home Remedies for Mild Piles

These are home remedies that only apply to mild symptoms of piles and should not substitute the medical treatment by professionals.  In case symptoms persist or worsen even after a couple of days of trying these remedies, seek medical attention by visiting a piles specialist near you to get an appropriate assessment. Home remedies are most effective when you use them together with lifestyle adjustments and a diet that corrects the causes of hemorrhoid development.

• Sitz Baths: Soak the anal area in warm water for 10–15 minutes, 2–3 times a day, to reduce swelling, pain, and promote blood circulation to the affected area 
• Fiber-Rich Diet: Consume fruits, vegetables, and whole grains to soften the stool and minimize straining during defecation 
• Hydration: Drink enough water throughout the day (8-10 glasses) to avoid constipation and keep stools soft and easy to pass 
• Avoid Prolonged Sitting: Reduce pressure on the rectal area by taking regular breaks from sitting every hour, especially during long work sessions. 
• No Straining: Use the toilet as soon as the urge arises and avoid forcing bowel movements or holding the breath while pushing.

Complications If Piles Are Left Untreated

Untreated hemorrhoids can lead to serious complications that may require emergency medical intervention. While many cases resolve on their own or with simple treatments, ignoring persistent symptoms can result in worsening conditions such as:

• Iron Deficiency Anemia: Continuous bleeding, especially from internal piles, can lower red blood cell levels. This may result in fatigue, dizziness, and weakness over time. 
• Strangulated Hemorrhoids: Prolapsed piles can become trapped and lose their blood supply. This causes intense pain and may lead to tissue damage or infection. 
• Thrombosed Piles: Blood clots can form in external piles, creating firm, painful lumps near the anus. These may cause sudden swelling and discomfort during movement or sitting. 
• Infection: Skin around the piles can tear due to scratching or irritation. Bacteria may enter, leading to swelling, pus, and increased pain. 
• Worsening Prolapse: Internal piles can remain permanently outside the anus if you leave it untreated. This causes hygiene problems, constant discomfort, and further complications.

Pile Treatments

Pile treatments depend on the severity of symptoms and the grade of hemorrhoids. It is possible to manage many cases with conservative treatments, while severe cases require surgical treatment for piles. Treatment goals include reducing symptoms, preventing complications, and improving quality of life. The choice of treatment is individualized based on patient factors, symptom severity, and response to previous treatments:

• Lifestyle modifications: Dietary changes, increased physical activity, and improved bathroom habits form the foundation of treatment 
• Topical treatments: Creams, ointments, and suppositories for immediate symptom relief and local anti-inflammatory effects 
• Oral medications: Pain relievers, stool softeners, and supplements to address symptoms and underlying causes

Hemorrhoid medications focus on symptom management and preventing complications rather than curing the underlying condition. These medications reduce pain, inflammation, itching, and bleeding associated with hemorrhoids. Most piles medicines are available over-the-counter, though stronger formulations require a doctor’s prescription.

Types of Piles Surgeries

Piles operation becomes necessary when non-surgical treatments fail to provide relief or when hemorrhoids are severely prolapsed. Surgical procedures remove or reduce the size of hemorrhoids and prevent recurrence. 

• Rubber band ligation: Elastic bands are placed around internal piles to cut off the blood supply, causing them to shrink and fall off within a week 
• Sclerotherapy: Chemical injection causes piles to shrink by creating scar tissue that blocks blood flow to the hemorrhoid 
• Infrared coagulation: Heat treatment coagulates blood vessels in piles, causing them to shrink over several weeks 
• Hemorrhoidectomy: Surgical removal of external and prolapsed internal piles, most effective for severe cases, but requires longer recovery. 
• Stapled hemorrhoidopexy: Circular stapling device removes prolapsed tissue and repositions remaining hemorrhoidal tissue back to the normal position 
• Laser hemorrhoidoplasty: Laser energy shrinks hemorrhoidal tissue with minimal damage to surrounding areas, reducing pain and bleeding

Piles Treatment Cost

Piles treatment cost varies significantly based on the type of treatment, location, hospital facilities, and surgeon expertise. Conservative treatments are generally affordable, while surgical procedures involve higher costs due to hospital stays and specialist fees.

* Treatment prices are indicative and may vary by location, hospital, and individual medical needs.

Piles treatment cost may be partially covered by health insurance, particularly for medically necessary procedures. Patients should verify coverage details with their insurance providers before treatment.

Recovery After Piles Operation

Recovery from a piles operation requires careful attention to post-operative care instructions to ensure proper healing and prevent complications. Most patients can return to normal activities within 2-4 weeks, depending on the type of surgical procedure performed. 

Patients should focus on the following areas during the recovery period:

• Medication: Use medications as advised and complete any prescribed antibiotic courses to help prevent infection. 
• Diet: Eat soft, fiber-rich foods to avoid straining and maintain regular, comfortable bowel movements without causing trauma to surgical sites 
• Activity: Avoid heavy lifting, intense exercise, or prolonged sitting for at least 1–2 weeks after surgery to prevent increased pressure on healing tissues 
• Hygiene: Clean the surgical area gently with warm water after bowel movements and pat dry with soft tissue, avoiding harsh wiping 
• Follow-Up: Attend all scheduled medical reviews as recommended to monitor healing progress, address concerns, and ensure proper recovery

Tips To Prevent Piles

Prevention strategies focus on reducing pressure on rectal and anal veins while promoting healthy bowel habits. These lifestyle modifications can significantly reduce the risk of developing piles or prevent existing hemorrhoids from worsening. Most prevention methods involve simple dietary and lifestyle changes that improve overall digestive health. 

Consistency in following these preventive measures helps to avoid piles:

• Increase fiber intake: Consume 25-35 grams of fiber daily from fruits, vegetables, and whole grains. 
• Stay hydrated: Drink 8-10 glasses of water daily to soften stools. 
• Avoid prolonged sitting: Take hourly breaks, especially during long periods at a desk. 
• Exercise regularly: Physical activity improves circulation and prevents constipation. 
• Respond to urges promptly: Use the toilet as soon as the urge arises to avoid straining. 
• Avoid straining: Don’t force bowel movements or hold breath while pushing. 
• Maintain a healthy weight: Reduce excess pressure on pelvic veins. 

Piles are a common condition that many people face worldwide. Recognizing the symptoms early and understanding the causes can help with quick treatment and prevent complications. With the right medical care, most individuals find relief through simple treatments and medications. For severe cases, surgery offers effective long-term solutions, but it’s important to consider costs when planning for care.

If you experience persistent bleeding, pain, or other concerning symptoms, consult a qualified proctologist for proper diagnosis and personalized treatment recommendations.