Piles Symptoms

Symptoms of Piles

What is Piles?

In the anal canal, there are certain vascular structures (smaller capillaries lining the anus or lower rectum) which help control the stool movement, that are known as Hemorrhoids. They can also be defined as clumps or masses of tissue in the anal canal that is full of blood vessels, muscle, support tissue and elastic fiber. So, when these structures inflame or swell they result in a condition called as Piles.There is a huge myth surrounding this disease, many people wrongly infer any symptom around the anal-rectal area as the same. This disease is fairly common and can possibly happen to anyone at any age. Around 50% of people experience them at some stage of their life; however it is more prevalent among elderly people and pregnant women. In order to ensure proper diagnosis one needs to assess the symptoms correctly.

Symptoms of Piles

Symptoms usually depend upon the size and type of Hemorrhoid (external or internal). Internal hemorrhoids (inside the anus) are usually associated with painless rectal bleeding, while external hemorrhoids (outside the anus) cause significant pain and swelling of the anus. Typically, internal piles occur from 2 to 4 cm above the anal opening while the external piles occur on the outer anal edge. The internal ones are more common than the external ones. Piles are usually not painful unless they become strangulates and bulge outside the anus. For such cases, the muscles around the anus tighten around the hemorrhoid causing it to become hard and painful. Internal and external hemorrhoids occur differently; however, many people have a combination of the two. The patient encounters significant amount of bleeding but life threatening anemia is rare. A lot of people feel embarrassed while facing the problem and seek medical care only when the case is in the advanced stage.

Internal & External Hemorrhoids
Diagram demonstrating the anal anatomy of both internal and external hemorrhoids. Source-Wikipedia

So, what are the most common symptoms of piles?

  • Uncomfortable and painful bowel movement
  • Itching caused mainly due to friction created by swollen hemorrhoids
  • Bright red anus bleeding. Blood may streak the bowel movement or the toilet paper
  • Painful swelling or lump around the anal region
  • A white mucous anal discharge
  • Soreness or inflammation around the anal area
  • Constipation
  • Sense of fullness in the anus

External Hemorrhoids/ Perianal Haematoma

External hemorrhoids cause irritation as they can clot under the skin, resulting in a hard painful lump. This is called a thrombosed or clotted hemorrhoid. There are cases when blood may pool under the skin and streaks of blood are noticed after straining to pass a stool. Typically rectal pain gets resolved within 2-3 days. However the swelling takes a while to disappear completely, leaving behind a skin tag. If the size of hemorrhoid is large, there will be hygienic concerns, irritation, inflammation and itchiness around the anus.

Internal Hemorrhoids

Painless, bright red, rectal bleeding during or following a bowel movement usually occurs for patients suffering from internal hemorrhoids. Typically, the blood covers the stool (hematochezia), or is smeared on the tissue paper, or drips in the toilet bowl. There is no change in the stool color. As stated above, internal hemorrhoids are swollen smaller veins that line the anal canal. But they sag and swell which makes them bulge out of the anus all the time. Bulged out hemorrhoids when squeezed by the anal muscles restrict blood flow, making the condition extremely painful. This results in mucous secretion. Other symptoms include:

  • Itching: This is a frequent complain as internal hemorrhoids often seep mucus which chafe anal skin.
  • Skin irritation: Bulging large hemorrhoids secrete mucous leading to mild irritation
  • Discomfort: The patient often feels the urge to poop right after having a bowel movement. This uncomfortable feeling is caused due to the hanging swollen tissue mass. Larger the hemorrhoid, greater is the discomfort.
  • Pain: Internal hemorrhoids generally are not painful. A strangulated, large hemorrhoids cause severe pain for which immediate treatment is required.

In general, depending upon the severity and size, they can be classified into grades 1 to 4:

Internal Hemorrhoids
Fig: Grade 1 and 2 are initial stages and are relatively less painful. Larger haemorrhoids cause mucous discharge, itch, irritation and pain.
Grade 3 and 4 are painful advanced stages and occurs due to thrombosis within the haemorrhoid.



Grade 1 is distinguished by smaller swellings found on the inner lining of the back passage. They cannot be seen or felt from outside the anus.

Grade 2 are larger and may be pushed out slightly (prolapse) from the anus while bowel movement, but quickly spring back inside.

Grade 3 hang out from the anal region. They small soft lumps that can be pushed back inside again.

Grade 4 permanently hang down from within the anus and cannot be pushed back inside. They are larger in size.

For the majority of cases, piles can be treated with the help of OTC medications effectively along with good fluid intake and a rich fiber diet. However for severe cases, piles have to be surgically removed. On an average 10% patients who seek medical intervention do require surgery.