Hemorrhoids, also known as piles, are swollen veins in the anal canal. They can be internal, occurring inside the anus, or external, occurring outside. Common symptoms include bleeding after passing stool and a feeling of fullness in the anus. Hemorrhoids are often caused by increased pressure in the anal region from constipation, straining during bowel movements, pregnancy, or aging. Treatment focuses on softening stools with fiber, drinking water, losing weight if obese, and using painkillers or corticosteroids for relief of symptoms. Surgery to remove hemorrhoids may be needed in severe cases.

1. 1
Piles (hemorrhoids) are swellings that can occur inside and around the anus and the
anal canal.
Piles can be of various sizes and may be internal (inside the anus) or external
ones (outside the anus). Typically, internal piles occur above the opening of the
anus. External piles (perianal hematoma) occur on the outside edge of the anus.
- The internal ones are much more common.
- Some people develop internal and external piles at the same time.
There is a network of small veins (blood vessels) within the lining of the anal canal.
These veins sometimes become wider and engorged with more blood than usual. The
engorged veins and the overlying tissue may then form into one or more small swellings
called piles.
Types of piles
Internal piles (hemorrhoids) are those that form above a point 2-4 cm inside the back
passage (anus) in the upper part of the anal canal. Internal piles are usually painless
because the upper anal canal has no pain nerve fibers.
External piles are those that form below that point, in the lower part of the anal canal.
External piles may be painful because the lower part of the anal canal has lots of pain
nerve fibers.
Internal piles can be classified into grades 1 to 4 according to their severity and size:
 1st
degree piles may bleed but don’t come out of your anus.
 2st
degree piles come out of your anus when you have a bowel movement, but go back
inside on their own afterwards.
 3st
degree piles come out of your anus and only go back inside when you push them in.
 4st
degree piles are always partly outside your anus and you can’t push them back in.
They may become very swollen and painful if the blood inside them clots.

2. 2
Causes
The exact reason why the changes in the veins within the lining of the anal canal occur
and lead to piles forming is not clear. Some piles seem to develop for no apparent
reason. However, it is thought that an increased pressure in and around the back
passage (anus) and anal canal can be a major factor in many cases.
- Certain situations increase the chance of piles developing:
Constipation, passing large stools, and straining at the toilet. These increase the
pressure in and around the veins in the anus and seem to be a common reason for piles
to develop.
Pregnancy. Piles are common during pregnancy. This is probably due to pressure
effects of the baby lying above the rectum and anus.
Ageing/aging. The tissues in the lining of the anus may become less supportive as we
get older.
Hereditary factors. Some people may inherit a weakness of the wall of the veins in the
anal region.
Symptoms
- The most common symptom is bleeding after passing stools (bright red color).
- Prolapse (hang down).
- Painless, pain, irritation, discharge, and itch.
- You may have a sense of fullness in the anus.
- Sometimes no symptoms may be present and a person may not realize that they have
piles.
Diagnosis
- Rectal examination.
- Sigmoidoscopy.
- Anoscopy

3. 3
Complication
- Anemia.
- Strangulated hemorrhoid: the blood supply to an internal hemorrhoid is cut
off, causing severe pain, and even gangrene (death of tissue).
Treatment
Diet
- Eating a high-fiber diet will make your stools softer and easier to pass.
- Drink enough fluid.
Body weight
- If the patient is obese, losing weight may help reduce the incidence and
severity of hemorrhoids.
Corticosteroids
- Don’t use painkillers that have an opioid in them (like codeine), as these
could make you constipated.
Painkillers
- Such as acetaminophen.
Laxatives
Surgery
- Hemorrhoidectomy.