Haemorrhoids, commonly known as piles, are due to swollen blood vessels in or around the anus and rectum. The haemorrhoidal veins are located in the lowest part of the rectum and the anus. Sometimes these veins swell so that its walls become stretched, thin, and irritated by passing of stool or bowel movements.

Haemorrhoids are classified into two general categories: Internal and External.

Internal haemorrhoids lie inside the rectum and are difficult to see with naked eye or feel with hand. They don't usually hurt because there are less pain-sensing nerves in the rectum. Bleeding may be the only sign in many cases. Sometimes internal haemorrhoids  prolapse or enlarge and protrude outside the anal sphincter. In that case it may be seen outside or felt with hand as moist, pink pads of skin that are pinker than the surrounding area. Prolapsed haemorrhoids may hurt because they become irritated by rubbing from clothing and sitting. They usually recede into the rectum on their own; it can be even gently pushed back into place.

External haemorrhoids lie within the anus and are often uncomfortable. If an external hemorrhoid prolapse to the outside (usually in the course of passing a stool), it can be seen or felt. Blood clots sometimes form within prolapsed external haemorrhoids, causing an extremely painful condition called a thrombosis. When the external hemorrhoid becomes thrombosed, it can look rather frightening, turning purple or blue, and could possibly bleed. Despite their appearance, thrombosed haemorrhoids are usually not serious and will resolve themselves in about a week. If the pain is unbearable, the thrombosed hemorrhoid can be removed with surgery, which stops the pain.




Haemorrhoids are usually more common in elderly people and during pregnancy. It's likely that extreme abdominal pressure causes the veins to swell and become susceptible to irritation. The pressure can be caused by obesity, pregnancy, standing or sitting for long periods, straining or prolonged sitting during bowel movement, coughing, sneezing, vomiting and holding your breath while straining to do physical labour and poor posture.

Diet  plays an important role in haemorrhoids. People who consistently eat a high- fiber diet are less likely to get haemorrhoids, but those who prefer a diet high in processed foods are at greater risk of haemorrhoids. A low-fiber diet or inadequate fluid intake can cause constipation, which can contribute to haemorrhoids in two ways: it promotes straining on the toilet and it also aggravates the haemorrhoids by producing hard stools that further irritate the swollen veins.


Internal haemorrhoids are classified into four grades:

  • Grade 1 haemorrhoids are small inflammations, usually painless and remain inside the lining of the anus. They are not visible. Minor bleeding may occurs from time to time after a bowel movement.
  • In Grade 2 haemorrhoids, the swelling is larger than grade 1, but also inside the anus. When passing the stool, they may get pushed out, but returns spontaneously to its place afterwards unaided
  • Grade 3 haemorrhoids are often called 'prolapsed haemorrhoids '; these appear outside the anus. The patient may feel them hanging out. They must be pushed back manually with the fingers.
  • A grade 4 hemorrhoid has prolapsed - it protrudes constantly and will fall out again if pushed back into the rectum. There may or may not be bleeding. Prolapsed hemorrhoids can be painful if they are strangled by the anus or if a clot develops They are large and stay outside the anus all the time.

Internal piles are usually painless. There may be a constant feeling of vague discomfort. When the piles are prolapsed, this discomfort is increased; there may be bright red rectal bleeding during or following defecation; there may be discharge of mucus and itching in the anus.

External piles often cause itching, burning and may cause bleeding.  They are bluish colored masses of venous engorgement with severe pain and anal spasm. These are small lumps that are located on the outside edge of the anus. They are very itchy and can be painful if a blood clot forms inside (thrombosed external hemorrhoid).




Diagnosis is typically done by physical examination through a digital rectal examination (DRE) or use a proctoscope, a hollow tube fitted with a light. The proctoscope allows the doctor to see the anal canal and take a small tissue sample from inside the rectum, which can be sent to the lab for analysis.

Colonoscopy is an examination used to detect changes or abnormalities in the large intestine (colon) and rectum. During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum. A tiny video camera at the tip of the tube allows the doctor to view the inside of the entire colon. If necessary, polyps or other types of abnormal tissue can be removed through the scope during a colonoscopy. Tissue samples (biopsies) can be taken during a colonoscopy as well.

Sigmoidoscopy is an examination of the sigmoid colon( lower portion of the large intestine) by means of a flexible tube inserted through the anus





Bleeding per rectum is one of the commonest symptoms detected first by the patient. Long-term bleeding may  lead to chronic anemia. Another complication is prolapse of the rectum. Ulceration and secondary infection are common in many cases. Thrombosis and strangulated hemorrhoids in which the blood supply to an internal hemorrhoid is cut off, causing severe pain, and even gangrene (death of tissue) is a serious complication.

Anal bleeding and pain of any sort is alarming and should be evaluated; it can indicate a life-threatening condition, such as colorectal cancer. Haemorrhoids are the main cause of anal bleeding and are rarely dangerous, but a definite diagnosis from your doctor is essential




Management of Haemorrhoids

In majority of the cases, haemorrhoids resolve on their own by simple life style modifications. Treatments help to reduce the discomfort such as burning, itching, constipation, bleeding and so on.

Too much straining when doing bowel movements, due to constipation is one of the common causes of heamorrhoids. A change in diet can help keep the stools regular and soft. This involves eating more fiber, such as fruit and vegetables, or switching your cereal breakfast to bran.

Patient may be advised to increase his/her water consumption. Avoid too much caffeine , processed food and aerated drinks.

If the patient is obese, losing weight may help reduce the incidence and severity of haemorrhoids.

Sedentary life style is found to be one of the common causes for venous stasis. Regular exercise, preferably long walk shall help  the chances of haemorrhoids.

There are some over-the-counter (OTC) medications which help soothe the redness and swelling around the anus area. They do not cure piles, they only treat the symptoms. Do not use them for more than seven consecutive days - longer periods may irritate the anus area and cause skin thinning.

Homoeopathic remedies

Hamamelis virginica: Bleeding haemorrhoids. Any form of venous congestion and venous bleeding comes under the purview of this medicine and the rectal region is the most prominent. There is a feeling of soreness and bruised sort of sensation.

Ratanhia: Painful haemorrhoids. There is pain while passing stool and the pain persists for hours afterwards. The pain is as if there is broken glass inside the rectum. Sometimes there is pain as if a knife is thrust inside. Dry heat or burning may also be felt. This burning may be relieved by cold water.

Graphities: Haemorrhoids with constipation with hard,  knotty stools and united by mucous threads.  The patient may be obese, constipated  with history of skin eruptions this remedy is mostly indicated.

Nux vomica: Patients with haemorrhoids and having a sedentary life style.  People with more mental work with little physical activity and tends to take lot of rich food. Use of stimulants like liquor or cigarettes is also quite high. It not only cures the piles but also sets the gastrointestinal system in order again.

Aesculus Hippocastanum: There is pain in the back along with the piles. There may be pain in the rectum as if it is full of small sticks. More often, the piles is blind in character, which means that there is no bleeding.

Other medicines commonly used in homeopathy for haemorrhoids are Aloe socotrina, Nitricum acidum, Sulphur and Collinsonia canadensis




  • PUBLISHED DATE : May 11, 2016
  • PUBLISHED BY : Zahid
  • CREATED / VALIDATED BY : Dr. Eswara Das
  • LAST UPDATED ON : May 11, 2016


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