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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.

According to the US National Institutes of Health (NIH), symptomatic hemorrhoids affect at least half the American population at some time in their lives before the age of 50.

In the majority of cases, piles are effectively treated with over-the-counter medications, a good fluid intake, and by following a diet high in fiber. In severe cases, the piles may have to be surgically removed. About 10% of patients who go and see their doctor about piles eventually require surgical intervention


In most cases piles are not serious and go away on their own after a few days.An individual with piles may experience the following symptoms:

  • 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.

External hemorr hoids are called perianal hematoma. These 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.


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.

Risk factors

Risk factors of haemorrhoids or piles include:

  • Long term constipation due to lack of fiber in diet. Excessive straining leads to piles.

  • Diarrhea over long periods of time may also lead to piles.

  • Being obese or overweight raises risk of piles.

  • Regular lifting heavy objects and those who perform strenuous manual labor are at risk of piles.

  • Those whose occupation require sitting for long durations are at risk of pressure on the anal blood vessels that may lead to piles.

  • Pregnancy is one of the most common risk factors of piles. With the growing baby within the pelvis the blood vessels in the pelvis get pressed and this leads to enlargement of the anal and rectal blood vessels and development of piles. These piles usually disappear after child birth.

  • Risk of piles rises with age. Those over 50 are at a greater risk of piles. This is because the supporting tissues of the rectum and anal canal get weaker with age and thus give way to allow piles to develop.

  • Some individuals have a familial risk of developing piles. They may inherit weaker blood vessels that have a greater risk of swelling and leading to piles.

  • Infections around the anal canal also render the blood vessels weak and straining and constipation may raise the risk of piles.

  • Liver cirrhosis leads to swollen and engorged veins within the rectum called varicose veins. These may occur without constipation and may lead to bleeding and other complications. Ascitis or collection of excess fluids within the abdomen also leads to risk of piles. Ascitis is caused by liver diseases like cirrhosis. The swollen abdomen also presses on the blood vessels leading to piles.

  • Chronic cough persistently raises the pressure within the abdomen and may lead to piles

  • Persons practicing anal intercourse over a prolonged period of time are at risk of piles. This is caused by weakening of the anal and rectal muscles.

  • Persons who have had surgery of the rectum or anus before are at a similar risk of piles since the muscles of their rectum and anus may be weak and straining may lead to piles.

When to see a doctor

A doctor can usually diagnose piles after carrying out a physical examination, examining the patient’s anus.

Before your appointment, you may want to write down:

  • If you’re experiencing any type of rectal bleeding
  • If the hemorrhoids are causing you pain or discomfort
  • If the problems persist despite trying over-the-counter hemorrhoid creams or other remedies
  • If you’re passing stools that look maroon in color or tarry in color, a sign of bleeding

Dr. Vishal Sharma

General Physician (Sharma Clinic)

You can reach Dr. Vishal Sharma by calling him on +91-9915086368 or click here to book an appointment online to visit him.