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

What is Piles (Haemorrhoids)?

Piles, also known as haemorrhoids or Bawaseer, are swollen and inflamed veins in the rectum or around the anus. They can develop inside the rectum (internal piles) or under the skin around the anus (external piles). This condition is very common and can affect both men and women. It is estimated that nearly 70% of people will experience piles at some point in their lives. People with piles may notice symptoms such as pain, itching, discomfort during bowel movements, or small amounts of bleeding. The common risk factors include chronic constipation, prolonged sitting, straining during bowel movements, and pregnancy.

How Do Piles Develop?

Piles, also known as haemorrhoids, develop when the veins in the lower rectum or anus become swollen due to continuous pressure. This pressure may result from chronic constipation, straining during bowel movements, sitting for long periods, obesity, pregnancy, or even frequent heavy lifting.

When this pressure builds over time, the blood vessels stretch and enlarge, leading to the formation of one or more haemorrhoids. These can appear either internally (inside the rectum) or externally (under the skin around the anus). Internal piles may not always cause pain but can lead to bleeding, while external piles may be painful, itchy, or uncomfortable.

Understanding how piles form is important to prevent them from worsening. Early lifestyle changes, such as improving diet and hydration, can help reduce symptoms. However, if symptoms persist or become severe, medical attention may be necessary for effective treatment.

What Do Piles Look Like?

Piles, or haemorrhoids, can appear differently depending on their type, severity, and location. Not all piles are visible to the naked eye, especially in the early stages.

Internal piles develop inside the rectum and are usually not visible. They often do not cause pain but may lead to symptoms like bleeding during bowel movements or a feeling of fullness. In more advanced cases, internal piles may bulge out of the anus, appearing as soft, moist, pink or red lumps. These may go back in on their own or may need to be gently pushed back.

External piles, on the other hand, form under the skin around the anus. These may appear as small, round, swollen lumps that can be skin-coloured or have a bluish tint—especially if a blood clot (thrombosed pile) is present. They may cause pain, itching, or irritation, particularly when sitting or passing stool.

The appearance of piles can vary between individuals, and some may not experience any visible signs at all. If you notice any unusual lumps, bleeding, or discomfort near the anal area, it is best to consult a doctor for a proper diagnosis and to discuss suitable treatment options.

Symptoms of Piles (Haemorrhoids)

Recognising the early signs of piles is important to prevent complications and seek appropriate treatment.

Common Symptoms of Piles

If you are wondering what are the symptoms of piles or how to know if you have piles, here are the most common signs to look out for:

1. Bleeding During Bowel Movements

One of the earliest and most noticeable haemorrhoids symptoms is bleeding while passing stool. You might see bright red blood on toilet paper or in the toilet bowl. Though not always painful, rectal bleeding should never be ignored and must be evaluated by a doctor.

1. Pain or Discomfort in the Anal Area

External piles can cause sharp pain, especially while sitting or during bowel movements. If a blood clot forms inside the pile (thrombosed haemorrhoid), the pain may be intense and sudden.

1. Swelling or a Lump Around the Anus

You may feel a small, soft, or swollen lump near the anal opening. This could be due to external piles or prolapsed internal piles. The lump might be tender, itchy, or cause discomfort while sitting or walking.

1. Itching, Burning, or Irritation

Many people with piles experience itching or a burning sensation around the anus. This is often due to inflammation or mucus discharge. It can lead to skin irritation and hygiene issues if not treated.

1. A Feeling of Incomplete Bowel Emptying

Internal piles may cause a persistent sensation that your bowel hasn’t emptied completely, even after passing stool. This can be frustrating and may lead to frequent trips to the toilet.

Symptoms by Type: Internal vs External Piles

Understanding the difference between internal and external piles can help identify the symptoms more clearly:

• Internal Piles
  Develop inside the rectum and are usually painless, especially in the early stages. Common signs include:
  • Painless rectal bleeding
  • A feeling of fullness or incomplete bowel evacuation
  • Prolapse (piles bulging out of the anus) in more advanced cases
• External Piles
  Occur under the skin around the anus and are typically more painful due to the presence of nerve endings. Symptoms may include:
  • Pain or discomfort, especially when sitting
  • Visible swelling or lumps
  • Itching or irritation
  • Bluish discolouration if a blood clot is present (thrombosed piles)

Signs You Should Not Ignore

While many cases of piles resolve with lifestyle changes or mild treatment, some symptoms may indicate a more serious issue. You should see a doctor immediately if:

• Heavy or frequent rectal bleeding
• Dark red or black stools
• Sudden or severe anal pain
• A hard, painful lump near the anus
• Dizziness, fatigue, or signs of anaemia due to blood loss
• No relief from over-the-counter treatments or lifestyle changes

Ignoring these signs may lead to complications such as thrombosis, strangulated piles, or chronic discomfort.

What causes Piles?

Understanding what causes Piles can help you take steps to prevent or manage the condition more effectively. Several factors can increase the risk of developing piles in both men and women:

1. Chronic Constipation or Straining During Bowel Movements

Straining increases pressure in the rectal veins, causing them to swell. Hard stools and difficulty passing stool are major contributors to this.

1. Sitting for Long Periods

A sedentary lifestyle or sitting on the toilet for extended periods can restrict blood flow and add pressure to the rectal area.

1. Low-Fibre Diet

Diets lacking in fibre can lead to hard stools and constipation, making bowel movements more difficult and painful.

1. Heavy Lifting

Repeatedly lifting heavy objects, either at work or in the gym, can put extra pressure on the rectal veins.

1. Obesity and Lack of Physical Activity

Excess body weight and poor activity levels can contribute to poor bowel habits and pressure on the anal region.

1. Ageing

As people age, the tissues supporting the veins in the rectum and anus may weaken, increasing the risk of piles.

Additional Causes of Piles in Women

Women may be more prone to developing piles due to factors related to pregnancy and childbirth:

• Pregnancy

The growing uterus puts pressure on the rectal veins, while hormonal changes during pregnancy may slow digestion, leading to constipation.

• Childbirth

The strain during vaginal delivery can cause or worsen piles, especially if pushing is prolonged.

• Hormonal Changes

Shifts in hormone levels during pregnancy, menstruation, or menopause can lead to constipation, increasing the risk of piles.

• Postpartum Inactivity

Limited movement after childbirth can further increase the chances of developing or worsening piles.

Piles (Haemorrhoids) – Risks & Complications

While piles (haemorrhoids) are not usually life-threatening, they can cause significant discomfort and may lead to complications if not treated on time. Understanding the possible risks and complications during and after treatment, as well as the consequences of leaving piles untreated, can help you make informed decisions about your health.

Risks if Piles is Left Untreated

Ignoring piles symptoms for too long can lead to complications that may impact your daily life and overall health. If left untreated, piles can:

• Worsen over time, causing increased pain, swelling, and discomfort
• Lead to blood clots (thrombosis), resulting in sharp pain and inflammation
• Cause strangulated piles, where the blood supply is cut off—a medical emergency
• Result in chronic bleeding, which may lead to iron-deficiency anaemia
• Affect your sleep, hygiene, and emotional well-being, especially in severe or recurring cases

How to Prevent Piles?

Certain lifestyle changes can significantly reduce your risk of developing piles or prevent existing symptoms from worsening.

Although there is no guaranteed way to completely prevent piles, following healthy habits can help keep your digestive system in good shape and reduce strain on the rectal veins.

1. Eat a Fibre-Rich Diet

One of the most effective ways to prevent piles is by eating plenty of fibre. A high-fibre diet keeps stools soft and easy to pass, which helps reduce straining during bowel movements – a leading cause of piles. Include foods such as:

• Whole grains (brown rice, oats, whole wheat)
• Lentils, beans, and peas
• Fresh fruits (like apples, pears, bananas, and berries)
• Vegetables (broccoli, spinach, carrots, Brussels sprouts)

If your diet lacks fibre, you are more likely to suffer from constipation, which increases your chances of developing external piles or worsening your current condition.

2. Stay Hydrated

Drinking enough water is just as important as eating fibre. Aim for at least 6–8 glasses of water a day. Proper hydration keeps your stool soft, reduces the risk of constipation, and supports overall digestive health. This is key when considering how to cure piles or prevent flare-ups.

3. Don’t Delay Bowel Movements

When you feel the urge to go, do not wait. Holding in stool for too long causes it to become hard and dry, making it more difficult to pass and increasing pressure on the anal area. Ignoring the urge repeatedly may worsen your symptoms if you already have piles.

4. Avoid Straining and Sitting Too Long on the Toilet

Straining during bowel movements puts excessive pressure on the veins in your rectum, contributing to the development of haemorrhoids. Likewise, sitting on the toilet for extended periods—especially while scrolling through your phone—can worsen this pressure. Keep your toilet visits brief and comfortable.

5. Use the Right Toilet Posture

A squatting position is considered more natural and can make passing stool easier. You can mimic this by using a small footstool to elevate your legs while sitting on the toilet. This reduces pressure on the rectal veins and may help treat piles more gently.

6. Stay Physically Active

Regular physical activity encourages healthy digestion and reduces the risk of constipation. It also improves circulation, which can reduce swelling and discomfort caused by piles. Try to include moderate exercises like:

• Brisk walking
• Yoga
• Light jogging or swimming

These are especially beneficial for people who sit for long hours at work, as prolonged sitting can make piles symptoms worse.

7. Maintain a Healthy Weight

Being overweight increases abdominal pressure and the risk of developing piles. Maintaining a healthy weight through balanced eating and regular exercise can go a long way in preventing piles and managing current symptoms.

8. Avoid Lifting Heavy Objects Improperly

Improper lifting techniques – especially when lifting heavy objects – can lead to sudden pressure on the lower abdomen and rectum. If your job involves physical work, learn the correct way to lift and always engage your core muscles to avoid unnecessary strain.

Piles (Haemorrhoids) Diagnosis

Early and accurate diagnosis is important to determine the right treatment and avoid complications.

1. Self-Diagnosis of Piles

If you are experiencing piles symptoms, such as:

• Bright red blood in your stool or on toilet paper
• Pain or discomfort during or after bowel movements
• Itching, burning, or swelling near the anus
• A lump or swelling around the anal area
• A feeling of incomplete bowel evacuation

2. Diagnosis by a Doctor

Diagnosing piles accurately is important for determining the most effective treatment plan. At the initial stage, the doctor—typically a proctologist or anorectal specialist—will assess your condition through a combination of medical history, physical examination, and diagnostic procedures. Here’s how the diagnosis is carried out:

• Medical History

The doctor begins by discussing your symptoms, such as blood in stool, anal itching, pain, or swelling. You may also be asked about bowel habits, diet, lifestyle factors, and any past occurrences of piles or related conditions.

• Physical Examination

A visual inspection of the anal area is done to check for external piles or signs of irritation, lumps, or thrombosis. This helps identify external haemorrhoids and visible inflammation.

• Digital Rectal Examination (DRE)

A gloved, lubricated finger is gently inserted into the rectum to feel for internal piles, tenderness, or unusual growths. This helps assess internal piles symptoms that are not visible externally.

• Anoscopy or Proctoscopy

If internal piles are suspected, the doctor may perform an anoscopy or proctoscopy. These procedures use a small, lighted tube to get a clearer view of the anal canal and lower rectum, helping evaluate the size and severity of the piles.

• Sigmoidoscopy

Sigmoidoscopy is a diagnostic test that uses a lighted tube to examine the rectum and lower colon. It helps identify internal piles and rule out other causes of symptoms such as rectal bleeding or discomfort.

• Colonoscopy

Colonoscopy helps examine the colon or the large intestine to check the abnormalities inside it. A colonoscopy evaluates rectal bleeding due to piles or other causes and rules out more serious problems so the doctor can suggest the most appropriate treatment for piles.

Foods to Avoid and Include in Piles

Understanding what to eat and what to avoid is essential, especially if you are currently undergoing piles treatment, recovering from a piles operation, or trying to manage early symptoms. Here’s a simple guide to help you make informed dietary choices.

Foods to Avoid in Piles

1. Spicy Foods

Spicy foods can irritate the digestive tract and worsen symptoms like itching, burning, or pain around the anus. For people with piles, such irritation can make bowel movements more uncomfortable and increase inflammation. It is best to reduce or avoid chilli-heavy or overly seasoned meals until symptoms improve.

2. Processed and Fast Foods

Processed foods such as packaged snacks, instant noodles, frozen meals, and fast-food items are often low in fibre and high in unhealthy fats. These foods slow down digestion and increase the risk of constipation — one of the leading causes of piles. Straining during bowel movements due to constipation puts extra pressure on the anal veins, making piles worse.

3. Alcohol and Caffeine

Excessive intake of alcohol or caffeinated drinks like tea and coffee can dehydrate the body. Dehydration leads to harder stools and increases the chances of constipation. This, in turn, can cause or worsen piles symptoms. Limiting alcohol and caffeine consumption is advisable, especially during treatment and recovery.

4. Low-Fibre Foods

Foods low in fibre — such as white bread, white rice, pasta made from refined flour, and certain dairy products — can cause irregular bowel movements. These items do not add bulk to the stool, making it harder and more difficult to pass. To avoid straining, it is better to switch to high-fibre alternatives.

Foods to Include in Piles

1. Leafy Green Vegetables

Spinach, kale, lettuce, fenugreek leaves, and other leafy greens are rich in dietary fibre, vitamins, and water content. These vegetables support smooth digestion and help prevent constipation. They also have anti-inflammatory properties, which may help reduce the swelling caused by piles.

2. Whole Grains

Whole grains such as oats, brown rice, quinoa, whole wheat bread, and bran contain insoluble fibre that adds bulk to the stool. This makes bowel movements easier and more regular, reducing the need for straining and helping in the natural management of piles symptoms.

3. Fresh Fruits

Fruits like bananas, apples (with skin), oranges, pears, berries, and papaya are excellent for people with piles. These fruits are high in fibre and water, which help in softening stools and improving bowel function. Bananas are particularly beneficial as they aid in smooth digestion and are rich in potassium, which supports muscle function in the intestines.

4. Legumes and Nuts

Legumes such as lentils, chickpeas, beans, and peas are high in soluble and insoluble fibre. Including them in your diet can improve digestion and prevent constipation. Nuts and seeds (like almonds, walnuts, and flaxseeds) are also great sources of healthy fats and fibre. However, they should be consumed in moderation and preferably soaked or roasted for easier digestion.

Types of Piles

There are four main types of Piles (haemorrhoids), each with its own symptoms and treatment approaches: internal haemorrhoids, external haemorrhoids, prolapsed haemorrhoids, and thrombosed haemorrhoids.

1. Internal Haemorrhoids

Internal Haemorrhoids develop deep inside the rectum and usually do not cause pain because there are few pain-sensitive nerves in that area. They are often not visible and may go unnoticed. However, larger internal piles can cause symptoms like bleeding during bowel movements, itching, or a burning sensation. Sometimes, straining during bowel movements can push these haemorrhoids out, leading to a prolapsed haemorrhoid.

2. External Piles

External piles, or external haemorrhoids, develop under the skin around the outer part of the anus. They are visible or can be felt as small lumps or bumps near the anal opening. Because this area is rich in nerve endings, external piles can cause noticeable discomfort, especially while sitting, walking, or during bowel movements.

Common symptoms of external piles include pain, itching, swelling, and sometimes bleeding. These symptoms may worsen with straining during stool, prolonged sitting, or poor hygiene.

In mild cases, conservative treatments such as warm sitz baths, topical ointments, high-fibre diets, and pain relievers can help manage the discomfort and reduce inflammation. However, if the condition progresses or if a thrombosed external pile forms—where a blood clot develops within the haemorrhoid—more advanced medical intervention may be needed.

When conservative measures do not provide relief, or if the piles become severe, surgical treatments like laser surgery or stapled hemorrhoidectomy may be recommended. These procedures are designed to offer quick relief with minimal pain and downtime, helping restore comfort and quality of life. For advanced or recurring cases, MIPH (Minimally Invasive Procedure for Haemorrhoids) is also considered an effective surgical option.

3. Thrombosed Haemorrhoids

Thrombosed Haemorrhoids occur when a blood clot forms inside a haemorrhoid, causing intense pain, swelling, redness, and itching. Although not life-threatening, thrombosed piles require prompt medical attention. Treatment usually involves a minor surgical procedure called a thrombectomy, where the clot is removed. This is different from a haemorrhoidectomy (piles surgery), which removes the haemorrhoid itself.

4. Prolapsed Haemorrhoids

Prolapsed Haemorrhoids are internal piles that have slipped outside the anus. They are classified into four grades depending on the severity:

• Grade 1: These are the mildest internal piles. They are small and remain inside the rectum, usually causing no visible symptoms. Treatment typically involves conservative methods such as lifestyle changes, increased fibre intake, sitz baths, and the use of topical creams or ointments to ease discomfort.
• Grade 2: These piles are larger and may protrude during bowel movements but retract back inside on their own. Non-surgical treatments like rubber band ligation, infrared coagulation, and sclerotherapy are often effective in managing Grade 2 piles.
• Grade 3: Grade 3 piles prolapse outside the anus during bowel movements and must be manually pushed back. They may cause pain, itching, bleeding, and hygiene issues. Similar to Grade 2, treatment may include rubber band ligation, infrared coagulation, or sclerotherapy, depending on severity.
• Grade 4: The most severe type, Grade 4 piles, remain prolapsed and cannot be pushed back. These are large, inflamed, and can cause intense pain and bleeding. They may also be complicated by thrombosis (blood clots) or strangulation. Surgical intervention is usually necessary at this stage, with options including laser surgery and stapled haemorrhoidectomy, which aim to provide effective relief with minimal recovery time.

10 Best Home Remedies for Piles

Piles (haemorrhoids) can disrupt daily life, causing discomfort, itching, pain, and even bleeding. These swollen veins in the rectal or anal area can be classified into different grades depending on their severity. While piles may sound like a minor issue initially, the treatment approach greatly depends on the grade of the condition.

Home remedies are effective only for Grade 1 piles, where symptoms are still mild and manageable. In Grade 1, the haemorrhoids are internal and may bleed but do not prolapse (bulge out). This stage can often be reversed or controlled with the right lifestyle changes and natural remedies.

However, for Grade 2, 3, and 4 piles, which involve prolapse and worsening discomfort, home remedies are not enough. These advanced stages require medical or surgical intervention, which is where our experienced doctors at Pristyn Care excels with minimally invasive laser and surgical procedures that offer long-term relief and quicker recovery.Here are 10 of the best natural home remedies for Grade 1 piles:

• High-Fibre Diet

A diet rich in fibre, including fruits, vegetables, legumes, and whole grains, can help soften stools and promote regular bowel movements, reducing the need to strain and preventing the condition from worsening.

• Coconut Oil

Coconut oil has natural anti-inflammatory and moisturising properties. Applying a small amount to the affected area can help reduce irritation, pain, and swelling.

• Witch Hazel

Witch hazel acts as a natural astringent and can be applied topically to relieve itching, discomfort, and inflammation. It can be used in liquid form with a cotton pad or found in medicated wipes.

• Avoid Straining

One of the key contributors to piles is straining during bowel movements. Avoid sitting for long periods on the toilet and respond promptly to the urge to go.

• Ice Packs

Applying a cold compress or ice pack wrapped in a cloth to the affected area for 15-minute intervals can help reduce swelling and numb the area, offering temporary relief.

• Hydration

Drinking plenty of water throughout the day helps prevent constipation and supports smooth bowel movements. Proper hydration is essential for overall digestive health.

• Warm Sitz Baths

Soaking the anal area in warm water for 15–20 minutes a few times a day can help soothe irritation, relieve discomfort, and promote healing. Adding Epsom salt may provide additional relief.

• Aloe Vera

Pure aloe vera gel has natural anti-inflammatory properties and can be applied gently to the affected area to soothe irritation and support tissue repair.

• Apple Cider Vinegar

When diluted properly, apple cider vinegar can help reduce inflammation and itching. Use with care by diluting it in water and applying gently using a cotton ball.

• Regular Exercise

Light physical activity, such as walking or yoga, improves bowel function and circulation while helping to prevent constipation and excess pressure on rectal veins.