What are the symptoms of haemorrhoids (piles)?

There are two main types of haemorrhoids. The ones you can see and the ones you can’t.

Types of piles

External haemorrhoids are the type you can usually see. They appear like small lumps that occur underneath the skin and around the anus.

Internal haemorrhoids, on the other hand, you rarely see or feel. This is because they occur inside the rectum.

What does a prolapsed haemorrhoid look like?

Occasionally, an internal haemorrhoid may prolapse. It will look like a pink lump that bulges outside of the anal canal, rather than under the skin around the anus. They go back inside on their own, but you should be able to push them back in.

However, the muscles in your rectum may cut off the blood supply to a prolapsed haemorrhoid. This is known as a strangulated haemorrhoid and requires surgery.

Are haemorrhoids purple?

Sometimes, an external haemorrhoid can turn blue or purple. This happens when a blood clot occurs inside the blood vessel of the haemorrhoid. The condition is called a thrombosed haemorrhoid. It’s not usually serious, but it can be uncomfortable.

Piles, especially external piles, have several clear symptoms.

You may feel:

• itching in and around the anus
• pain around the anus, especially after a bowel movement
• like you still need to have a bowel movement after going to the toilet

With internal piles, you won’t feel anything and you may not even know they’re there.

Yes, one of the defining symptoms is bleeding. This happens when the blood vessels are damaged from straining. You’ll usually notice bright red blood in your stools or on the toilet paper after you wipe. As well as blood, you may also see mucus. This will appear like a clear discharge that leaks from the anus and irritates the skin.

If you have a thrombosed haemorrhoid, blood pressure may build up inside which can cause it to burst. This can cause:

• continuous and heavy bleeding
• passage of blood clots
• severe pain

If you experience any of these symptoms, then you should seek immediate medical attention.

You should never ignore blood in your stools, but that doesn’t mean it’s always serious. Here are a few conditions that are similar to piles.

Anal fissures

An anal fissure is a tear or an open sore that develops in the lining of the large intestine. Similar to piles, they cause sharp pain and bleeding when you have a bowel movement. They also are mild and should go away without treatment.

Anal skin tags

Anal skin tags appear like small bumps around the back passage which can be confused for piles. They tend to start small but grow bigger over time. However, unlike piles, they don’t often cause any pain or bleeding. But, they can be caused by frequent piles or fissures.

Skin tags are often harmless, but you will likely need to get them removed.

Bowel disease

Several long-term conditions can cause blood in your stools.

• inflammatory bowel syndrome (IBS) - a common condition that causes recurrent diarrhoea and/or constipation
• ulcerative colitis - a long-term condition that causes inflammation of the large intestine and rectum
• Crohn’s disease - a long-term condition that causes inflammation in different parts of the digestive system

These diseases can also cause fissures and haemorrhoids. You must go to your doctor to rule out these conditions, especially if you regularly have piles.

Anal fistula

An anal fistula is a small tunnel that develops between the end of the bowel and the skin near your anus. It is usually the result of an infection near the anus which causes a collection of pus (abscess) to develop in the nearby tissue.

As well as rectal bleeding and pain, it can also cause:

• a smelly discharge
• a high temperature (fever)
• swelling and redness in the anus
• difficulty controlling bowel movements

If you have these additional symptoms, it may not be piles. In any case, go to your doctor for medical advice and get your symptoms looked at.

Bowel cancer

Bowel cancer is the general term for cancer affecting the large intestine. It’s one of the most common types of cancer and is usually linked to unexplained persistent symptoms, pain and weight loss. One of the main symptoms is blood in your stools.

While it is unlikely to be the cause of these symptoms, especially if you’re younger, it’s still important for your doctor to rule it out.

The first step to treating piles is lifestyle changes. You may need to improve your diet such as eating more fibre and drinking more fluids. You should also try to improve your bowel habits such as by not ignoring the urges to go and not spending too much time on the toilet.

Your pharmacist can also suggest gentle over-the-counter laxatives which can help make your bowel movements more regular or paracetamol to help with the pain. Don’t use any stronger painkillers like ibuprofen or codeine as they can cause constipation.

There are also several prescription treatments available. These include creams, ointments and suppositories that help relieve any itching and pain. If you’re anxious to go to the doctor, you can use our online consultation service. Get prescription treatment online and discreetly delivered to your door.

While there are surgical treatments available, such as rubber band ligation and stapling, these are only reserved for the most severe cases.