Piles are divided into two categories- internal piles and external piles.
As the name suggests, internal piles occur inside the anal canal, but they can also come out and hang outside your anus. This type of piles is further classified on the basis of whether they come out of the anus and if they do, how far are they out. They are classified as-
- First degree– This type of piles do not come out of the anus but might bleed
- Second degree– They come out during a bowel movement but then go inside later
- Third degree– They come out but will go inside if you push them
- Fourth degree– They are partially out of your anus and cannot be pushed inside. They can swell and can result in immense pain if blood clotting occurs inside the lump
External piles, on the other hand, occur close to the anus below the anal canal. They too can be painful if blood clots inside the lumps.
Causes of piles
Piles develop when the veins in your anal canal become swollen, which may happen for a number of reasons, such as:
- if you strain when you go to the toilet, for example if you have constipation or long-lasting diarrhoea
- getting older – your anal canal weakens with age, which makes piles more likely
- having a persistent cough
- lifting heavy objects
Piles are also common during pregnancy. They may develop due to the higher pressure in your tummy (abdomen) when you’re pregnant. They usually get better after you give birth.
Some people believe there’s a link between stress and piles but there’s no evidence to support this. But having piles can be potentially stressful.
Another theory is that you’re more likely to get piles around the time of your period. But there’s currently no evidence to support this.
It is not necessary for piles to readily show any noteworthy symptoms. If there are symptoms, they might include-
- A lump around or in the anus
- Bleeding during the bowel movement
- Leaking faeces or slimy mucus discharge from the anus
- Feeling of constipation
- The skin around the anus feels sore or itchy
- In case of external piles, feeling of discomfort and pain after bowel movement
Complications of piles
Piles rarely cause any serious problems but sometimes they can lead to the following.
- External piles (swellings that develop further down your anal canal, closer to your anus) can become inflamed and swollen; ulcers can also form on them.
- Skin tags can form when the inside of a pile shrinks back but the skin remains. For more information, see our FAQ: Are skin tags the same as piles? below.
- If mucus leaks from your anus, it can make the surrounding skin very sore.
- Internal piles that prolapse (hang down) can sometimes get strangulated and lose their blood supply. If a blood clot forms (thrombosis), piles can be very painful. External piles can also become thrombosed.
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