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Haemorrhoids (Piles): Symptoms, Grades, Diagnosis, Treatment & Prevention

  • Prof. Dr. Zahid Mahmood
  • August 9, 2026

Haemorrhoids (Piles): Symptoms, Grades, Diagnosis, Treatment & Prevention

Medically reviewed by Prof. Dr. Zahid Mahmood, MBBS, FCPS — General, Laparoscopic & Laser Surgeon, Lahore.

Haemorrhoids—commonly called piles or bawaseer—are enlarged, symptomatic anal cushions. They may cause bright-red bleeding, itching, mucus discharge or a lump that comes out during a bowel movement. They are common and treatable, and many patients improve without an operation.

The most important safety message is simple: bleeding from the back passage should not automatically be blamed on piles. Other bowel conditions can cause the same symptom, so a proper medical assessment is essential.

What are haemorrhoids?

Everyone has soft anal cushions containing blood vessels and supporting tissue. These cushions help seal the anal canal. Haemorrhoidal disease develops when they enlarge, bleed or slide downwards and prolapse.

Haemorrhoids themselves are not cancer and do not turn into cancer. However, rectal bleeding can also occur with polyps, inflammatory bowel disease, colorectal cancer and other conditions. Finding piles does not always prove they are the only source of bleeding.

Internal and external haemorrhoids

  • Internal haemorrhoids arise inside the anal canal. They commonly cause painless, bright-red bleeding or prolapse.
  • External haemorrhoidal disease affects vessels beneath the sensitive skin around the anal opening. A clot can produce a sudden, painful lump.
  • Mixed haemorrhoids contain both internal and external components.

Anal skin tags are often mistaken for external piles, but they are not the same condition.

The four grades of internal haemorrhoids

  • Grade I: bleeding without prolapse.
  • Grade II: prolapse during straining, then return inside by themselves.
  • Grade III: prolapse and require gentle manual replacement.
  • Grade IV: remain permanently prolapsed and cannot be reduced.

The grade helps guide treatment, but symptoms, the external component, previous treatment and patient preference also matter.

Why do piles develop?

Repeated straining, raised abdominal pressure and weakening of the supporting tissue can cause the anal cushions to become congested and move downwards. Contributing factors include:

  • Constipation and straining
  • Prolonged sitting on the toilet
  • A low-fibre diet
  • Pregnancy and childbirth
  • Age-related weakening of supporting tissue
  • Chronic diarrhoea or irregular bowel habits
  • Obesity and prolonged inactivity

Using a phone or reading while sitting on the toilet can unintentionally prolong straining and should be avoided.

Symptoms of haemorrhoids

Common symptoms include:

  • Bright-red blood on toilet paper or a fresh splash in the toilet
  • A lump that appears during bowel movements
  • Itching or irritation around the anus
  • Mucus discharge, dampness or minor soiling
  • A feeling of incomplete evacuation
  • Discomfort from prolapse

Uncomplicated internal haemorrhoids usually bleed without severe pain. Marked pain may indicate an anal fissure, abscess, thrombosed external haemorrhoid or strangulated prolapse and deserves examination.

Warning signs that need medical assessment

Arrange a medical review for any rectal bleeding, especially if it is new or recurrent. Seek prompt or urgent care for:

  • Heavy, continuous or recurrent bleeding
  • Dizziness, faintness, shortness of breath or unusual tiredness
  • Dark or black stool, or blood mixed through the stool
  • A lasting change in bowel habit
  • Unexplained weight loss or abdominal pain
  • A family history of colorectal cancer
  • A sudden, extremely painful anal lump
  • A painful prolapse that cannot be pushed back

These features do not necessarily mean cancer or another dangerous condition, but they should not be ignored.

How are haemorrhoids diagnosed?

Diagnosis begins with a private discussion about bleeding, pain, prolapse, bowel habits, medicines and family history. The doctor then examines the anal area and may perform a gentle digital rectal examination.

A proctoscopy or anoscopy uses a short instrument to inspect the anal canal and identify internal piles. Selected patients may need a flexible sigmoidoscopy or colonoscopy—for example, when the source of bleeding is uncertain, symptoms continue after treatment, or other colorectal warning features are present.

First-line treatment: fibre and healthy toilet habits

Dietary and behavioural measures are the first treatment for most symptomatic piles:

  • Increase fibre through vegetables, fruit, pulses, whole grains or psyllium (isabgol).
  • Drink enough fluid unless a doctor has restricted your intake.
  • Avoid straining and prolonged toilet sitting.
  • Respond to the urge to pass stool rather than delaying.
  • Use a stool softener or bulking agent if advised.
  • Stay active and address persistent constipation or diarrhoea.

Short-term creams or suppositories may relieve itching and discomfort, but they do not correct significant prolapse. Products containing steroid or local anaesthetic should not be used indefinitely without medical advice.

Office treatments

Most grade I and II haemorrhoids—and selected grade III disease that does not improve with conservative treatment—can be treated without formal surgery.

Rubber-band ligation

A small elastic band is placed above the pain-sensitive part of the anal canal. It cuts off the blood supply, allowing the treated tissue to shrink and separate within several days. Mild pressure and a small amount of delayed bleeding can occur. Significant bleeding, fever, urinary difficulty or increasing pain requires urgent advice.

Injection sclerotherapy

A sclerosant is injected above the sensitive area to produce fibrosis and reduce bleeding or prolapse. It can help selected early internal haemorrhoids. Accurate placement by a trained clinician is essential.

Infrared coagulation is another office option used in some centres. The choice depends on the haemorrhoid pattern, available expertise, medicines such as blood thinners and patient preference.

Treatment for prolapsing or advanced haemorrhoids

Haemorrhoidal artery ligation (HAL)

Doppler guidance may be used to locate and tie the arteries supplying the piles, sometimes combined with sutures that lift prolapsing tissue. It is used mainly for grade II and III internal haemorrhoids. Early pain is often less than after excisional surgery, although recurrence can occur.

Stapled haemorrhoidopexy

This procedure removes a ring of tissue above the haemorrhoids and lifts the prolapse. Recovery may be quicker and less painful than conventional excision, but recurrence is more frequent and rare serious complications can occur. It is not routinely the first surgical choice.

Excisional haemorrhoidectomy

Surgical removal remains an effective and durable treatment for symptomatic grade III or IV, mixed internal and external disease, or haemorrhoids that have not responded to office procedures. Recovery is more uncomfortable than after many less-invasive procedures, but modern pain control, warm baths, fibre and stool-softening treatment help considerably.

What about laser treatment for piles?

“Laser” is not one single procedure. In laser haemorrhoidoplasty, a fibre delivers energy inside the haemorrhoidal tissue to shrink it while limiting external wounds. Some studies suggest less early postoperative pain and a quicker return to activity than excisional surgery in selected patients.

However, laser is not automatically painless, permanent or suitable for every grade. Long-term recurrence, cost and the presence of a large external component must be considered. Major guidelines continue to support fibre, office procedures and excisional haemorrhoidectomy as established treatments. A qualified surgeon should explain whether laser, banding, artery ligation or excision best matches the individual disease.

Recovery after treatment

Recovery varies considerably:

  • After banding or injection: many patients return to routine activity quickly, with mild discomfort for a short period.
  • After minimally invasive treatment: recovery is often faster than after excisional surgery, but individual experience varies.
  • After haemorrhoidectomy: pain is expected during the first bowel movements and gradually improves. Warm baths, prescribed pain relief, fibre, fluids and stool softeners are important.

After any procedure, seek urgent advice for heavy bleeding, fever, increasing pain, difficulty passing urine, faintness or inability to pass stool or gas.

Haemorrhoids during pregnancy

Piles are common during pregnancy because of increased abdominal pressure, hormonal changes and constipation. Treatment usually begins with fibre, fluids, activity and pregnancy-safe symptom relief advised by the obstetric team. Many cases improve after delivery. Procedures are reserved for persistent or complicated disease and should be individually planned.

Can piles be prevented?

Not every case can be prevented, but healthy bowel habits reduce symptoms and recurrence:

  • Keep stool soft with adequate fibre and fluid.
  • Avoid repeated straining.
  • Do not remain on the toilet longer than necessary.
  • Exercise regularly and maintain a healthy weight.
  • Treat persistent constipation or diarrhoea.

Common questions

Do all piles need surgery?

No. Many improve with fibre, better bowel habits or a simple office procedure. Surgery is mainly used for advanced, mixed, recurrent or treatment-resistant disease.

Can piles become cancer?

No. Haemorrhoids do not turn into cancer. Rectal bleeding still needs assessment because piles and colorectal disease can produce similar symptoms or coexist.

Are piles caused by spicy food?

Spicy food may aggravate discomfort in some people, but it is not a primary cause. Constipation, straining, pregnancy and weakening of supporting tissue are more important factors.

Is laser always the best treatment?

No. The best option depends on the grade, symptoms and external component. A treatment should be selected because it suits the disease—not simply because it has a modern-sounding name.

Key message

Piles are common, treatable and nothing to be embarrassed about. Bright-red bleeding and prolapse are typical, but rectal bleeding should always be assessed rather than self-diagnosed. Most patients start with fibre and healthier toilet habits; banding and other office procedures treat many early cases, while surgery remains effective for advanced disease.

Consult a piles surgeon in Lahore

Prof. Dr. Zahid Mahmood can assess rectal bleeding or prolapse, confirm the diagnosis and explain the most appropriate treatment—from conservative care and banding to laser or conventional surgery.

For an appointment, call 0300 413 0159 or visit professorzahid.com.

This article is for general education and does not replace personal medical assessment. Heavy bleeding, faintness, fever, severe pain or an irreducible prolapse needs urgent medical attention.

Medical references

  1. Williams NS, O’Connell PR, McCaskie AW, editors. Bailey & Love’s Short Practice of Surgery. 28th ed. CRC Press; 2023. Chapter 80, “The anus and anal canal,” pp. 1430–1434.
  2. Hawkins AT, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Diseases of the Colon & Rectum. 2024;67(5):614–623.
  3. NHS. Piles (haemorrhoids): symptoms, self-care and treatment.
  4. NICE. Haemorrhoid grading and established treatments.

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