Introduction

Piles is one of those medical conditions that a large number of people silently suffer from for years without seeking help. The discomfort is real, the impact on daily life is significant, but the topic carries enough social stigma in India that most patients delay consulting a doctor — sometimes for years — hoping the problem will resolve on its own.

It rarely does. And in the meantime, what starts as mild discomfort can progress into a painful, bleeding, and severely uncomfortable condition that interferes with every aspect of daily life.

The truth is that piles — medically known as haemorrhoids — is an extremely common condition. Research suggests that nearly 75 percent of people will experience haemorrhoids at some point in their lifetime, and in India, it is estimated that over 75 million people are currently affected. It is not a condition to be ashamed of, and more importantly, it is a condition that is very effectively treated.

In this comprehensive guide, Dr. Hamikchandra Patel — gastroenterologist and laparoscopic surgeon at Shaleen Multi Speciality Hospital, Sola, Ahmedabad — explains piles in complete detail: what it is, why it develops, how to identify it, and what your treatment options are at every stage.

What Are Piles (Haemorrhoids)?

Haemorrhoids are swollen, inflamed veins located in and around the rectum and anus. They are similar in nature to varicose veins — the same process of vein swelling and engorgement that occurs in the legs can occur in the blood vessels of the lower rectum.

Under normal circumstances, these veins exist in everyone — they are a natural part of the anal canal’s vascular structure and play a role in controlling bowel movements. The problem arises when they become enlarged, inflamed, or prolapsed due to increased pressure over time.

Piles is not a dangerous or life-threatening condition in most cases, but it can cause significant bleeding, pain, itching, and discomfort — and in advanced stages, it requires surgical intervention to resolve.

Types of Piles — Internal vs External

Understanding the type of piles you have is important because it determines the symptoms you experience and the treatment approach that is most appropriate.

Internal haemorrhoids: Located inside the rectum, above the dentate line. Because there are very few pain-sensitive nerves in this area, internal haemorrhoids are often painless — but they bleed easily during bowel movements. In more advanced cases, they can prolapse — meaning they push out through the anal opening.

External haemorrhoids: Located under the skin around the anus, below the dentate line. This area has many pain-sensitive nerves, which is why external haemorrhoids are often painful, particularly when they become thrombosed (when a blood clot forms inside the vein). They may appear as a lump or swelling around the anus.

Mixed haemorrhoids: A combination of both internal and external haemorrhoids occurring together, which is quite common in advanced or long-standing cases.

The Four Grades of Internal Haemorrhoids

Internal haemorrhoids are classified into four grades based on their severity. This grading system directly guides treatment decisions.

Grade I: The haemorrhoid is present inside the rectum but does not prolapse. The main symptom is bleeding during bowel movements — typically fresh, bright red blood on the toilet paper or in the toilet bowl. No lump or protrusion is felt.

Grade II: The haemorrhoid prolapses out of the anus during straining or bowel movement but returns inside on its own without any manual assistance. Bleeding continues and mild discomfort may be felt.

Grade III: The haemorrhoid prolapses during bowel movement and does not return inside on its own — it needs to be pushed back manually with a finger. At this stage, discomfort, mucus discharge, and itching become more pronounced alongside bleeding.

Grade IV: The haemorrhoid is permanently prolapsed outside the anus and cannot be pushed back inside even manually. This grade involves significant pain, constant discomfort, heavy bleeding, and often requires surgical treatment.

What Causes Piles?

Piles develop when the veins around the lower rectum and anus are subjected to prolonged or excessive pressure that causes them to stretch and swell. The most common contributing factors include:

Chronic constipation: Straining during bowel movements is one of the leading causes of haemorrhoids in India. The effort of passing hard, infrequent stools puts intense pressure on the rectal veins repeatedly over time.

Low-fibre diet: A diet low in fruits, vegetables, and whole grains leads to harder stools and constipation — directly increasing haemorrhoid risk.

Prolonged sitting on the toilet: Spending extended time on the toilet — a very common habit, often compounded by phone use — creates sustained pressure on the anal veins.

A sedentary lifestyle: Lack of physical activity slows digestion, contributes to constipation, and reduces healthy blood circulation in the pelvic region.

Pregnancy: The growing uterus puts increasing pressure on the pelvic veins during pregnancy. Combined with hormonal changes that relax vein walls, haemorrhoids are extremely common in pregnant women, particularly in the third trimester.

Obesity: Excess body weight increases pressure on the pelvic and rectal veins chronically.

Chronic diarrhoea: Repeated loose stools cause frequent straining and irritation of the anal area, which can also trigger haemorrhoid development.

Ageing: The tissues supporting the veins in the rectum and anus naturally weaken with age, making haemorrhoids more likely in people above 45.

Heredity: A family history of haemorrhoids increases your personal risk, suggesting a genetic predisposition to weaker vein walls in the rectal area.

Symptoms of Piles — Recognising the Warning Signs

Symptoms of piles vary depending on the type and grade. Here are the most common ones to be aware of:

Rectal bleeding: The most common symptom of internal haemorrhoids. You may notice bright red blood on toilet paper after wiping, drops of blood in the toilet bowl, or blood on the surface of your stool. Importantly, this blood is always bright red — dark or tarry blood suggests bleeding higher in the digestive tract and requires separate investigation.

Pain and discomfort around the anus: More characteristic of external haemorrhoids, particularly when thrombosed. The pain can range from mild soreness to sharp, severe pain that makes sitting and walking uncomfortable.

Itching or irritation: A persistent itching sensation in and around the anus, often caused by mucus secretion from prolapsed haemorrhoids irritating the surrounding skin.

A lump near the anus: A soft, fleshy lump that is tender to touch, located around the anus — indicative of an external haemorrhoid or a prolapsed internal haemorrhoid.

Sensation of incomplete bowel emptying: Many patients with internal haemorrhoids feel as though their bowel has not emptied completely even after a bowel movement — a sensation caused by the bulk of the prolapsed tissue.

Mucus discharge: A small amount of mucus or slime on the toilet paper or in underwear, often accompanied by mild itching and skin irritation around the anus.

Faecal soiling: In advanced cases where haemorrhoids prevent complete anal closure, involuntary leakage of small amounts of faecal matter can occur.

When Should You See a Doctor?

Many people manage mild piles symptoms at home for a period of time with dietary changes and over-the-counter creams. However, you should consult a gastroenterologist without delay if:

You notice any rectal bleeding — even if you suspect it is from piles, bleeding should always be evaluated by a doctor to rule out other causes including colorectal polyps or colorectal cancer.

Your symptoms are not improving after two weeks of dietary changes and home management.

You are experiencing significant pain that is interfering with daily activities.

A prolapsed haemorrhoid cannot be pushed back inside.

You are experiencing mucus discharge, skin irritation, or soiling.

Dr. Hamikchandra Patel at Shaleen Multi Speciality Hospital, Sola, Ahmedabad, provides comprehensive evaluation and treatment for all grades of haemorrhoids, from early-stage conservative management to advanced surgical procedures.

Treatment Options for Piles

Treatment for piles depends on the grade and severity of the condition. There is a clear progression from conservative management to minimally invasive procedures to surgery as the grade advances.

Dietary and lifestyle changes (all grades, first-line treatment):

Increasing fibre intake through fruits, vegetables, whole grains, and legumes is the single most effective long-term measure for managing and preventing piles. High-fibre diets soften stools, reduce straining, and decrease pressure on rectal veins. Aim for 25 to 30 grams of fibre per day.

Drinking 8 to 10 glasses of water daily prevents hard stools. Avoiding prolonged toilet sitting, taking short walks after meals, and establishing a regular bowel routine all contribute meaningfully to symptom relief.

Topical medications: Over-the-counter haemorrhoid creams and suppositories containing hydrocortisone, lidocaine, or witch hazel can reduce inflammation, pain, and itching temporarily. These manage symptoms but do not treat the underlying haemorrhoid.

Rubber band ligation (Grade I, II, and some Grade III): A very effective, quick, and largely painless office procedure for internal haemorrhoids. A small rubber band is placed at the base of the haemorrhoid, cutting off its blood supply. The haemorrhoid shrinks and falls off within 7 to 10 days. No anaesthesia is required and most patients resume normal activities the same day. Multiple sessions may be needed for multiple haemorrhoids.

Sclerotherapy (Grade I and II): A chemical solution is injected into the haemorrhoid tissue, causing it to shrink and harden. Best suited for smaller internal haemorrhoids. Quick, minimally invasive, and performed as an outpatient procedure.

Infrared coagulation (Grade I and II): A beam of infrared light is used to create scar tissue at the base of the haemorrhoid, cutting off its blood supply and causing it to shrink. Another effective office-based procedure for early-grade haemorrhoids.

Surgical treatment — when is it necessary?

Surgery becomes the recommended treatment when haemorrhoids are Grade III or Grade IV, when minimally invasive procedures have failed or are not suitable, when thrombosed external haemorrhoids are causing severe pain, or when significant bleeding is not controlled by other means.

Conventional haemorrhoidectomy: Surgical removal of the haemorrhoid tissue under spinal or general anaesthesia. Highly effective with excellent long-term results. Recovery typically takes 2 to 3 weeks and may involve some post-operative pain.

Stapled haemorrhoidopexy (PPH — Procedure for Prolapse and Haemorrhoids): A technique particularly suited for Grade III and IV prolapsed haemorrhoids. A circular stapling device is used to remove a ring of the prolapsed tissue and staple the remaining tissue back into its normal position inside the anal canal. The staple line is above the pain-sensitive dentate line, resulting in significantly less post-operative pain compared to conventional haemorrhoidectomy. Recovery is faster — most patients are discharged within 24 hours.

Laser haemorrhoidoplasty: A newer technique using laser energy to shrink haemorrhoid tissue from within. It is minimally invasive, involves minimal bleeding, and offers faster recovery. Suitable for Grade I to Grade III haemorrhoids.

Dr. Hamikchandra Patel is experienced in the full range of surgical and non-surgical haemorrhoid treatments and will recommend the most appropriate option based on your specific grade, symptoms, and overall health.

Can Piles Be Prevented?

While there is no absolute guarantee of prevention — particularly if you have a family history or have been pregnant — the following measures significantly reduce your risk and prevent recurrence after treatment:

Eat a high-fibre diet consistently — this is the single most effective preventive measure.

Stay well hydrated throughout the day — at least 8 glasses of water daily.

Do not strain during bowel movements — if passing stool requires significant effort, your diet needs more fibre and water.

Never ignore the urge to have a bowel movement — delaying increases the chance of constipation.

Limit time spent sitting on the toilet — avoid reading or using your phone during bowel movements.

Exercise regularly — even a 30-minute daily walk improves bowel regularity and pelvic circulation.

Maintain a healthy body weight — obesity is a significant and modifiable risk factor for haemorrhoids.

Conclusion

Piles is far more common than most people realise — and far more treatable than most people fear. The key is to stop suffering in silence and seek medical attention before a manageable Grade I or Grade II condition progresses into a Grade III or Grade IV problem that requires surgery.

With modern minimally invasive techniques and advanced surgical options available today, treating piles is straightforward, effective, and associated with very good long-term outcomes.

If you are experiencing any of the symptoms described in this article — bleeding, pain, itching, lumps, or prolapse — do not delay your consultation.

Dr. Hamikchandra Patel is a Fellowship-trained gastroenterologist and laparoscopic surgeon at Shaleen Multi Speciality Hospital, Sola, Ahmedabad, with extensive experience in the diagnosis and treatment of haemorrhoids at every grade. To book your consultation, visit drgastro.in or call us today.