Usually not. Internal piles sit above the pain-sensitive part of the anal canal, so pain is not common. Prolapse, bleeding and itching are the more typical symptoms. Severe pain suggests an anal fissure or a thrombosed external pile rather than ordinary piles, and should be assessed.

Do I need surgery for piles?

Most people do not. The grade largely decides the approach. Diet, fibre and fluids may be enough for first-degree piles, and banding suits first, second and third-degree piles. Surgery is generally reserved for third and fourth-degree piles, or for symptoms that have not responded to simpler measures.

Can piles come back after treatment?

Yes, recurrence is possible after any treatment, and the chance varies by procedure. Banding may need to be repeated. Conventional haemorrhoidectomy is the most complete method but has the longest recovery, while less invasive options recover faster and carry a somewhat higher chance of symptoms returning. Keeping fibre and fluid intake up and avoiding straining helps.

Is bleeding from piles dangerous?

Bleeding from piles is usually small in volume and bright red, but it should not be assumed to be the cause. Where there has been bleeding, the colon above the rectum should be examined as well, to rule out other causes. Bleeding at times other than passing motion is a particular reason to get checked.

Will piles go away on their own?

Mild symptoms often resolve with self-care. If symptoms are no better after 7 days, or are getting worse, see a doctor. Piles that prolapse tend to progress over time rather than resolve, because the supporting tissue does not repair itself.

Patient guide

Piles (Haemorrhoids)

Piles (haemorrhoids) are soft, spongy cushions in the lining of the anus that can become swollen and slip down the anal canal, causing bleeding, discomfort and, in more severe cases, prolapse. Most cases are highly treatable.

Medically reviewed by Dr Chen Chung Ming, FRCS (Edin), FAMS · Colorectal Surgeon

Illustration of the large bowel with a cross-section of the anal canal showing a haemorrhoid. — Haemorrhoids form in the lining of the anal canal.

About Piles

The lining of the anus contains three cushions of soft, spongy padding that help seal the anus and prevent leakage of mucus. These pads (piles) are supported by connecting tissue and contain tiny blood vessels. Piles become problematic when the supporting structures no longer hold them in place and they slip down the anal canal; the blood vessels become engorged and the piles swell. In severe cases they may be pushed out of the anal canal during defecation. This is known as prolapsed piles.

Classification of Piles

First-degree piles remain in the anal canal and are usually painless.
Second-degree piles are pushed down during defecation but return spontaneously.
Third-degree piles are pushed down and usually require fingers to push them back in.
Fourth-degree piles are prolapsed and cannot be reduced; these are usually painful, uncomfortable and often bleed.

The grade largely determines which treatments are worth considering, so establishing it is the first step.¹

Pain is not a typical feature of internal piles as they sit above the pain-sensitive areas of the anal canal.¹ Severe pain usually means something else, such as an anal fissure or a thrombosed external pile, and should be assessed rather than treated as ordinary piles.

Contributing Factors

The precise cause is unknown, but contributing factors include:

Ageing
Chronic constipation or diarrhoea
Pregnancy
Hereditary factors
Repetitive or prolonged straining during bowel movements
Spending long periods on the toilet
Prolonged squatting or heavy lifting

Symptoms

Symptoms tend to come and go. You could have piles if you notice:

Bleeding with bright red blood during a bowel movement
Anal swelling during a bowel movement
Itching in the anal region
Aching pain and discomfort
Sensitive lump(s)
Soiling of underwear with mucus or faeces

Treatment

For mild symptoms you can help yourself by washing the area gently with lukewarm water, avoiding excessive straining and heavy lifting, and not spending long periods on the toilet. Clean the area gently rather than rubbing it after passing motion. Soaking in warm water soothes symptoms, a cool compress can help, and loose, soft cotton underwear reduces discomfort and stops moisture from building up.²

To reduce the chance of piles returning:²

Eat more high-fibre food such as vegetables and fruit, increasing the amount gradually
Drink more water, unless you have been told to limit fluids
Exercise regularly
Do not ignore the urge to open your bowels
Avoid sitting or standing for long stretches

A flavonoid tablet taken alongside a fibre supplement has also been shown to help.¹ If symptoms persist or worsen, consult your doctor. Treatment options include:

Ligation (banding) — a simple outpatient procedure in which a small rubber band encircles the base of the pile and cuts off its blood supply, so it falls off in a few days. It suits first, second and third-degree piles¹ and may need to be repeated. Occasionally there is bleeding one or two weeks afterwards, and it can be heavy,¹ so please do not hesitate to contact your doctor if that happens.
Conventional haemorrhoidectomy — the most complete method for third- and fourth-degree piles, done under general anaesthesia. The pile tissue is removed with diathermy and the wounds are left open to heal.¹ They may take 4–6 weeks to close, and pain afterwards is the main drawback. Around 1 to 2% of patients bleed 7 to 14 days after surgery, and fewer than 1% develop an abscess.¹
Stapled haemorrhoidectomy — uses a circular device to remove a cuff of supporting tissue above the piles, cutting their arterial inflow and lifting them back into position. Because the staple line sits above the pain-sensitive area, it causes considerably less discomfort than conventional surgery and allows an earlier return to normal activities.¹ It is more uncomfortable than banding but much less so than a haemorrhoidectomy. Its specific risks include damage to the rectal wall, sphincter problems, infection deep in the pelvis, persistent pain and urgency.¹
Transanal haemorrhoidal dearterialisation (THD) — a newer method that uses an ultrasound probe to find the blood vessels feeding the pile and close them off with stitches. Nothing is cut away, so discomfort is usually minimal and recovery quicker.

How Piles Are Diagnosed

Diagnosis starts with your symptoms and an examination. This usually includes an internal examination and a proctoscope, a short instrument that lets the doctor see the lower anal canal directly. That is normally enough to confirm piles and to work out which grade they are.

Piles are common, so finding them does not confirm that they are the cause of your bleeding, and something else can be present further along the bowel at the same time. Where there has been bleeding, the colon above the rectum is examined as well, to rule out other causes.¹ That usually means a colonoscopy if you are 50 or older, or if your symptoms do not fit straightforward piles.

Do Piles Lead to Cancer?

No. There is no link between piles and cancer. However, the symptoms of piles, especially bleeding, are similar to those of colorectal cancer.² Symptoms are worth investigating, and screening for colorectal cancer is recommended from age 50. A colorectal surgeon can assess your symptoms and advise which test is appropriate for you.

While piles do not become cancerous, assuming that bleeding is caused by piles can delay the diagnosis of another condition, which is generally easier to treat when found early.

When to See a Doctor

See a doctor if symptoms are no better after 7 days or are getting worse, and also if you notice any of the following:²

Unexplained loss of appetite and weight
Bleeding at times other than passing motion
Changes in bowel habits or movements
Changes in colour and shape of stools
Hard lumps at the anus

See a doctor early for severe, constant anal pain. It points away from ordinary internal piles and towards a fissure or a thrombosed external pile, which are managed differently.