Piles is another term for hemorrhoids. Hemorrhoids are collections of inflamed tissue in the anal canal. They contain blood vessels, support tissue, muscle, and elastic fibers.

Many people have piles, but the symptoms are not always obvious. Hemorrhoids cause noticeable symptoms for at least 50 percent of people in the United States (U.S.) before the age of 50 years. This article will explore piles, their causes, how to diagnose, grade, and treat them, and what effects they might have on the body.

FAST FACTS ON PILES:

Here are some key points about piles. More detail and supporting information is in the main article.

Piles are collections of tissue and vein that become inflamed and swollen.
The size of piles can vary, and they are found inside or outside the anus.
Piles occur due to chronic constipation, chronic diarrhea, lifting heavy weights, pregnancy, or straining when passing a stool.
A doctor can usually diagnose piles on examination.
Hemorrhoids are graded on a scale from I to IV. At grades III or IV, surgery may be necessary.

WHAT ARE PILES?

Piles are inflamed and swollen collections of tissue in the anal area. They can have a range of sizes, and they may be internal or external. Internal piles are normally located between 2 and 4 centimeters (cm) above the opening of the anus, and they are the more common type. External piles occur on the outside edge of the anus.

SYMPTOMS

In most cases, the symptoms of piles are not serious. They normally resolve on their own after a few days. An individual with piles may experience the following symptoms:

A hard, possibly painful lump may be felt around the anus. It may contain coagulated blood. Piles that contain blood are called thrombosed external hemorrhoids.
After passing a stool, a person with piles may experience the feeling that the bowels are still full.
Bright red blood is visible after a bowel movement.
The area around the anus is itchy, red, and sore.
Pain occurs during the passing of a stool.

Piles can escalate into a more severe condition. This can include:

excessive anal bleeding, also possibly leading to anemia
infection
fecal incontinence, or an inability to control bowel movements
anal fistula, in which a new channel is created between the surface of the skin near the anus and the inside of the anus
a strangulated hemorrhoid, in which the blood supply to the hemorrhoid is cut off, causing complications including infection or a blood clot

Piles is classified into four grades:

Grade I: There are small inflammations, usually inside the lining of the anus. They are not visible.
Grade II: Grade II piles are larger than grade I piles, but also remain inside the anus. They may get pushed out during the passing of stool, but they will return unaided.
Grade III: These are also known as prolapsed hemorrhoids, and appear outside the anus. The individual may feel them hanging from the rectum, but they can be easily re-inserted.
Grade IV: These cannot be pushed back in and need treatment. They are large and remain outside of the anus.

External piles form small lumps on the outside edge of the anus. They are very itchy and can become painful if a blood clot develops, as the blood clot can block the flow of blood. Thrombosed external piles, or hemorrhoids that have clotted, require immediate medical treatment.

CAUSES

Piles are caused by increased pressure in the lower rectum. The blood vessels around the anus and in the rectum will stretch under pressure and may swell or bulge, forming piles. This may be due to: