Piles are one of those conditions almost nobody wants to talk about, yet they're extremely common — most adults will experience them at least once, often without ever mentioning it to a doctor. That reluctance to discuss symptoms can mean people either put up with discomfort unnecessarily, or worry more than they need to about bleeding that's actually a routine and treatable part of the condition.
This guide explains what haemorrhoids are, why they happen, what actually helps, and — just as importantly — which symptoms mean it's time to stop self-treating and get things checked properly.
What haemorrhoids are and why they happen
Haemorrhoids are swollen, cushion-like blood vessels in and around the anus and lower back passage. Everyone has these vascular cushions normally — they help with continence — but when the pressure on them increases, they can enlarge, become engorged, and start to cause symptoms. At that point they're what people mean by "piles".
The most common trigger is straining on the toilet, which is usually a knock-on effect of constipation or, less often, frequent diarrhoea. Other contributing factors include pregnancy (from both hormonal changes and the physical pressure of a growing uterus), being overweight, heavy lifting, a persistent cough, and spending long periods sitting, especially on the toilet itself. Age plays a role too, as the tissue supporting these blood vessels naturally weakens over time.
Haemorrhoids are usually described as internal (inside the back passage, often painless but prone to bleeding) or external (under the skin around the anus, which can become painful, itchy or swollen, particularly if a blood clot forms within one — known as a thrombosed haemorrhoid). It's also possible to have both types at once, and internal haemorrhoids can prolapse to become visible externally, which is why the two categories aren't always as clear-cut in practice as they sound.
Common symptoms and how piles are graded
Typical symptoms include bright red blood on the toilet paper or in the pan after passing a stool, itching or irritation around the anus, a feeling of fullness or a lump near the back passage, and soreness or discomfort, especially during or after a bowel movement. Internal haemorrhoids can sometimes prolapse — bulge out through the anus — either only during straining or, in more advanced cases, more of the time.
Clinicians grade internal haemorrhoids from I to IV based on how much they prolapse: grade I don't prolapse at all, grade II prolapse on straining but go back in on their own, grade III prolapse and need to be pushed back in manually, and grade IV stay prolapsed permanently. This grading matters mainly because it guides which treatments are likely to help — mild, low-grade piles usually respond well to simple self-care, while higher grades are more likely to need a procedure.
It's worth knowing that piles are sometimes confused with an anal fissure — a small tear in the lining of the anus, which also causes bleeding but typically produces a sharper, more distinct pain during and shortly after passing a stool, rather than the dull ache or itch more typical of haemorrhoids. Because the two can look similar to the person experiencing them, a pharmacist or GP examination is the most reliable way to tell them apart if you're not sure which you're dealing with.
Self-care and lifestyle measures that help
For most people, the first and most effective step is addressing whatever is causing the straining in the first place. That means:
- increasing dietary fibre gradually — wholegrains, fruit, vegetables and pulses — to soften stools and reduce the need to strain
- drinking enough fluid through the day, since fibre needs this to work properly
- not delaying the urge to go to the toilet, and not sitting on the toilet longer than needed (avoid reading or scrolling on your phone while sitting)
- staying physically active, since prolonged sitting and inactivity both contribute to constipation
- keeping the area clean and gently dry rather than rubbing, and using plain water or fragrance-free wipes if toilet paper is irritating
Where constipation is the underlying driver and dietary changes alone aren't enough, a bulk-forming laxative is often the next step, since it works with the same fibre-and-fluid mechanism rather than stimulating the bowel artificially. A pharmacist can advise on which type suits your situation.
Toilet posture can also make a genuine difference: raising the knees above hip height with a small footstool changes the angle of the back passage and can make passing a stool easier and less forceful. It sounds like a small thing, but for many people it reduces the straining that keeps symptoms going, alongside the dietary changes above.
Over-the-counter creams and when to use them
Topical products won't cure haemorrhoids, but they can meaningfully ease the itching, soreness and swelling while the underlying cause resolves. Two main types are available over the counter:
- Soothing preparations containing ingredients such as local anaesthetics or mild astringents, which can be used for longer periods as symptoms need.
- Steroid-containing creams, such as those containing hydrocortisone, which reduce inflammation and itching more effectively but are generally recommended for short courses only, typically around a week, since prolonged use of topical steroids in this area can thin the skin.
Suppositories are an option for haemorrhoids higher up in the back passage, while creams and ointments are usually better suited to external symptoms. A warm bath can also bring welcome relief for external discomfort.
When symptoms need a doctor's assessment
Rectal bleeding is almost always caused by haemorrhoids when it happens, and in the vast majority of cases it's nothing more sinister than that. Even so, any new rectal bleeding is worth having checked by a doctor at least once, because other conditions — including some that need earlier treatment to do well — can cause similar symptoms, and it isn't possible to be sure of the cause from symptoms alone.
It's particularly important to get an assessment if bleeding is a new symptom for you, if it's accompanied by a change in your normal bowel habit that lasts more than a few weeks, unexplained weight loss, persistent abdominal pain, or if you're over 50 and haven't had rectal bleeding investigated before. A pharmacist or GP can usually tell fairly quickly, from your symptoms and a brief examination, whether further tests are needed or whether it's safe to continue with simple self-care.
You should also seek advice sooner rather than later if piles are very painful, if a lump around the anus has suddenly become hard and intensely painful (which can suggest a thrombosed external haemorrhoid), if symptoms haven't improved after about a week of self-care, or if piles keep recurring despite your best efforts with diet and fluids. Heavy rectal bleeding, bleeding accompanied by dizziness or feeling faint, or a large amount of blood mixed into the stool rather than just on the surface, needs urgent same-day attention — contact NHS 111 or your GP practice rather than waiting.
Procedures for piles that don't settle
When self-care and topical treatment aren't enough, several outpatient procedures can help, usually without the need for a hospital stay. Banding is the most commonly used option: a small band is placed around the base of the haemorrhoid to cut off its blood supply, so it shrinks and eventually falls away. It's typically well tolerated and can often be repeated if needed.
Other options a specialist might discuss include injection treatment (sclerotherapy), which shrinks the haemorrhoid with an injected solution, and infrared coagulation, which uses heat to achieve a similar effect. Surgery is reserved for larger, more advanced haemorrhoids, or for cases where less invasive procedures haven't worked — most people with piles never need it.
Whichever route is appropriate, the underlying habits that led to straining in the first place — low fibre intake, inadequate fluids, or delaying trips to the toilet — are worth addressing regardless, since they reduce the chance of piles coming back after any treatment.