Piles (haemorrhoids)
Also called: haemorrhoids, hemorrhoids, piles, bleeding piles
Piles (haemorrhoids) are swollen blood vessels in and around the back passage. They often cause bright red bleeding, itching or a lump. Most get better with soft stools, more fibre and water, and simple creams. Some need a small procedure or surgery.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Piles, also called haemorrhoids, are swollen cushions of blood vessels inside or around the anus (the opening of the back passage) and the lower rectum (the last part of the bowel). Internal piles form just inside the anus. They are usually painless but may bleed when you pass a stool. External piles form under the skin outside the anus and can be sore, especially if a blood clot forms in them.
Doctors grade internal piles from 1 to 4. Grade 1 piles stay inside. Grade 2 piles come out when you pass a stool and go back by themselves. Grade 3 piles have to be pushed back in with a finger. Grade 4 piles stay outside all the time.
Piles are very common. Straining on the toilet, hard stools and pregnancy all add pressure to these blood vessels. Many people get better within a few days with home care: drinking enough fluid, eating more fibre, and not sitting on the toilet for long. If symptoms keep coming back, a doctor can offer a quick clinic treatment such as banding. Surgery is kept for large or stubborn piles. Bleeding from the back passage can also come from other bowel problems, so it should always be checked by a doctor at least once.
In Pakistan
In a 2022 study of 103 patients with piles at a Rawalpindi hospital, most had constipation (about 79 in 100) or an inactive lifestyle (about 74 in 100), and about two in three did not eat fresh fruit and vegetables every day.
Symptoms
- Bright red blood on the toilet paper or in the toilet after passing a stool
- Itching around the anus
- A soft lump that comes out of the anus, which may go back by itself or need pushing back
- Pain or aching around the anus, especially when sitting or passing a stool
- A hard, very painful lump near the anus (a clot in an external pile)
- Slimy mucus in your underwear or on the toilet paper
- Feeling that the bowel has not fully emptied after going to the toilet
- Difficulty keeping the area clean after a bowel movement
Causes and risk factors
Causes
- Straining hard to pass a stool
- Long-lasting constipation and hard stools
- Sitting on the toilet for a long time
- Pregnancy and childbirth, which raise pressure in the lower belly
- Heavy lifting
- Some long-term illnesses, such as liver cirrhosis (scarring of the liver)
What makes it more likely
- A low-fibre diet with few fruits, vegetables and whole grains
- Not drinking enough water
- Ignoring the urge to pass a stool
- Being pregnant or having recently given birth
- Sitting for long periods and not being physically active
- Long-term cough or regular heavy lifting
- Being overweight
Complications
Most piles cause no lasting harm. A blood clot can form inside an external pile (a thrombosed pile). This causes sudden, severe pain and a hard lump, and the tissue nearby can die, so it sometimes has to be removed by a surgeon. Rarely, piles bleed heavily. Small amounts of blood lost over a long time can lead to iron-deficiency anaemia (low blood count), which makes you tired and breathless. Piles can come back even after treatment. Using steroid, numbing or antiseptic creams for a long time can cause skin allergy or irritation around the anus.
When to see a doctor
- Bleeding that will not stop, heavy bleeding, large clots or the toilet water turning red: go to the emergency department or call for an ambulance
- Feeling dizzy, light-headed or faint while bleeding: get emergency help
- Severe pain around the anus
- High temperature, feeling hot and shivery or generally unwell, or pus coming from the piles
- Bleeding together with tummy pain, a new or worsening change in bowel habit, or bleeding that continues despite treatment
- Symptoms that get worse or do not improve after a week of home treatment
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Diagnosis
A doctor usually diagnoses piles by asking about your symptoms and bowel habits and looking at the area around the anus. External piles can often be seen straight away. The doctor will usually do a rectal examination (gently feeling inside the back passage with a gloved finger) to check for other problems and to test the muscle tone. They may look inside with a short tube with a light, called a proctoscope or anoscope. This is quick and done in the clinic.
Rectal bleeding is not always from piles. Bowel cancer can bleed in a similar way. So your doctor may advise a colonoscopy or sigmoidoscopy (a camera test of the bowel) if no clear source of bleeding is found, if you also have tummy pain or a new change in bowel habit, or if bleeding continues even after the piles are treated.
Treatment
- Start with home care: drink plenty of fluid, eat more fibre, do not strain, and do not sit on the toilet for long.
- Treat any constipation. A pharmacist or doctor may suggest a fibre supplement or a laxative to keep stools soft.
- Use a short course of a cream, ointment or suppository with a mild steroid or a numbing medicine to ease pain, itching and swelling. Use paracetamol for pain.
- Avoid codeine-type painkillers, which cause constipation, and avoid ibuprofen if the piles are bleeding.
- If symptoms continue, a doctor can offer a clinic procedure such as rubber band ligation (banding), sclerotherapy (an injection to shrink the pile) or infrared coagulation (heat treatment).
- For large piles that stay outside (grade 3 or 4) or that do not respond to other treatment, a surgeon may advise an operation such as haemorrhoidectomy, stapled haemorrhoidopexy or haemorrhoidal artery ligation.
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
- Codeine-type painkillers (Paracetamol Codeine): Avoid, because they cause constipation and straining, which make piles worse
- NSAID painkillers when piles are bleeding (Ibuprofen): Avoid ibuprofen if your piles are bleeding
| Group | Role | Medicines |
|---|---|---|
| Topical corticosteroids (steroid creams and suppositories) | Ease swelling, itching and pain; use only for a short time because long use can irritate or sensitise the skin | Hydrocortisone (69 brands) |
| Local anaesthetics (numbing creams) | Short-term relief of pain and soreness around the anus | Lidocaine (75 brands) |
| Laxatives (stool softeners) | Keep stools soft so you do not need to strain, which helps piles heal and stops them coming back | Lactulose (74 brands) |
| Simple painkillers | Paracetamol is the usual painkiller for sore piles | Paracetamol (350 brands) |
Also used (not yet in our price list): Fibre supplements (bulk-forming agents), Pramocaine (pramoxine) creams, Flavonoid tablets (a doctor may suggest these)
Self-care and prevention
Self-care
- Drink plenty of water through the day to keep stools soft
- Eat more fibre: fruit, vegetables, whole grains, lentils and beans
- Go to the toilet when you feel the urge, and do not push hard or sit there for a long time
- Wipe gently with damp toilet paper and keep the area clean and dry
- Sit in a warm bath, or hold an ice pack wrapped in a towel against the area, to ease itching and pain
- Wear cotton underwear and try not to scratch
- Stay active and cut down on alcohol and caffeine
- If a pile comes out, gently push it back inside
Prevention
- Eat a high-fibre diet every day
- Drink enough fluid
- Do not strain or spend long periods on the toilet
- Treat constipation early
- Keep active and avoid long periods of sitting
Common questions
Do piles go away on their own?
Many small piles settle within a few days with soft stools, more fibre and water, and not straining. Piles can come back, especially if constipation continues. If they do not improve after a week of home care, or keep returning, see a doctor.
Is bleeding from piles dangerous?
Bleeding from piles is usually small and bright red. But rectal bleeding can also come from other bowel problems, including bowel cancer, so a doctor should check it. Heavy bleeding that will not stop, or bleeding with dizziness or fainting, needs emergency care.
Which painkiller is safe for piles?
Paracetamol is the usual choice. Avoid codeine-type painkillers because they cause constipation. Avoid ibuprofen if your piles are bleeding. Ask a pharmacist or doctor if you are unsure.
Do I need surgery for piles?
Most people do not. Home care and creams help most cases, and a quick clinic treatment such as banding works for many piles that keep causing symptoms. Surgery is mainly for large piles that stay outside the anus or that have not responded to other treatment.
Can I use pile creams during pregnancy?
Piles are common in pregnancy. Some creams with hydrocortisone or pramocaine are considered safe in late pregnancy, but always check with your doctor, midwife or pharmacist first. Keeping stools soft with fibre and fluids is the main step.
Sources
- NHS 111 Wales. NHS 111 Wales - Health A-Z : Haemorrhoids (2024).
- NICE. Radiofrequency treatment for haemorrhoids (Interventional procedures guidance IPG589) (2017).
- NICE. Treating haemorrhoids (piles) by tying off their blood supply (2010).
- American Family Physician (summary of American Society of Colon and Rectal Surgeons guideline). Management of Hemorrhoids: Guidelines From the ASCRS (2025).
- MedlinePlus (US National Library of Medicine). Hemorrhoids: MedlinePlus Medical Encyclopedia (2025).
- European Journal of Health Sciences (Sadiqa et al.). Risk Factors of Hemorrhoids in a Tertiary Care Hospital of Rawalpindi: A Descriptive Cross-Sectional Study (2022).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.