Piles (haemorrhoids): symptoms, causes, and when surgery helps

Piles — the everyday word for haemorrhoids — are one of the most common reasons adults quietly avoid seeing a surgeon. Bleeding on the paper, an itch that will not settle, a lump that comes and goes: symptoms are usually manageable, often curable, and almost never as embarrassing to discuss as patients fear. This guide covers what piles are, what causes them, when to see someone, and which treatments actually work.

What piles are

Everyone has haemorrhoidal cushions — spongy vascular tissue in the anal canal that helps you stay continent. Piles are what we call those cushions when they enlarge, bleed, prolapse, or become uncomfortable. They are not varicose veins, they are not a sign of cancer, and in most people they are a nuisance rather than a serious illness.

Piles are graded 1 to 4. Grade 1 bleeds but does not prolapse. Grade 2 prolapses when you strain and reduces on its own. Grade 3 needs to be pushed back manually. Grade 4 is permanently outside. The grade largely determines the right treatment.

Symptoms of piles

Bright red bleeding — usually on the paper or dripping into the bowl after passing stool.
A lump at the anus that appears when you strain and may or may not go back on its own.
Itching or a persistent damp feeling.
Discomfort after sitting — a dragging, full sensation rather than sharp pain.
Sudden severe pain — usually a thrombosed (clotted) external pile. Uncommon, but distinctive.

Severe, constant pain is not typical of ordinary piles. If that is what you are experiencing, an anal fissure, abscess or thrombosed pile is more likely, and each has its own treatment.

What causes piles

Piles are strongly linked to what you do in the bathroom, not to any single food. The consistent drivers are:

Constipation and straining.
Prolonged sitting on the toilet — reading, scrolling on a phone.
A low-fibre diet and inadequate fluid intake.
Pregnancy — hormones relax the vein walls and the growing uterus adds pressure.
Heavy lifting with poor breathing technique.
A family predisposition — some people simply inherit weaker connective tissue.

When to see a surgeon

See someone if you have any of the following:

Rectal bleeding, even once — piles are the commonest cause, but colon and rectal cancer can present the same way, and this is the single most important reason not to self-diagnose.
A lump that does not go back on its own.
Symptoms that keep returning after home treatment.
Iron-deficiency, unexplained weight loss, a change in bowel habit, or a family history of bowel cancer alongside bleeding.

At a first visit Dr Marais will take a careful history and do a gentle rooms-based examination that usually includes proctoscopy — a short, well-lubricated scope no wider than a finger. In most patients with new rectal bleeding a colonoscopy or flexible sigmoidoscopy is offered at the same visit to be certain the bleeding is only from piles.

Treatments that actually work

Diet and habit changes

Aim for 25 to 30 grams of fibre a day, 1.5 to 2 litres of water, and no more than two to three minutes on the toilet. This is not a token recommendation — for grade 1 piles it alone resolves symptoms in a large proportion of patients, and after any other treatment it is what stops piles coming back.

Rubber-band ligation (in the rooms)

The workhorse of piles treatment. A small elastic band is applied to the base of the pile through a proctoscope. The pile shrivels and drops off over the following week. There is no anaesthetic, no cut, and no time off work. Two to three bands are typically applied a few weeks apart. For symptomatic grade 1 and 2 piles, success rates are above 80%.

Injection sclerotherapy

An alternative in-rooms option for small piles, particularly in patients on blood thinners where banding is less suitable.

Haemorrhoidectomy

For grade 3 and grade 4 piles, or piles that have recurred after banding. A day-case operation under general or spinal anaesthesia. Definitive, with the lowest recurrence rate of any treatment. The first three to five days are uncomfortable — expect it, plan for it, and it passes.

Stapled haemorrhoidopexy (PPH)

For circumferential prolapsing piles, redundant tissue is lifted and stapled higher in the anal canal where there are no pain fibres. Recovery is noticeably quicker than conventional haemorrhoidectomy. Not every anatomy is suitable — the decision is made at consultation.

After treatment

Banding: back at your desk within an hour. Expect a small amount of bleeding around day 5 to 7 when the pile drops off. Haemorrhoidectomy: same-day discharge, one to two weeks off work depending on your job. The first few bowel motions are the most uncomfortable — laxatives, warm salt baths and simple analgesia get you through them. Full healing is four to six weeks.

Preventing recurrence

The single most useful habit is spending less time on the toilet. Piles are strongly connected to prolonged straining, and a phone on the toilet doubles the strain even when you do not feel it. Fibre, fluid, exercise, and treating a chronic cough or constipation early all lower recurrence.

A note on stigma

Piles are ordinary. About half of adults will have symptomatic piles at some point. There is nothing to be embarrassed about, and the earlier they are assessed the smaller the treatment tends to be. If you have been putting it off, this is your prompt.

To discuss piles treatment with Dr Marais, please send an enquiry or read the haemorrhoids & piles treatment page.