The term ‘Piles‘ is used to collect or group inflamed tissues in the anal canal. They hold and control blood vessels, support tissue, muscle, and elastic fiber. Another term for piles is hemorrhoids. Piles are present in different sizes. They may be present internally or externally.

Types of piles:

  1. Internal piles
  2. External piles

Internal piles

Internal piles are located between 2 and 4 centimeters above the opening of the anus.

External piles

External piles are found on the outside boundary of the anus.

Basic characteristics of Piles

  • Piles are the group of tissues that become inflamed.
  • Their size can vary or differ, and they can be inside and outside of the anal canal.
  • Piles arise because of chronic constipation, chronic diarrhea, lifting heavy weights, pregnancy, or straining when passing a stool.
  • There are grades of piles from I to IV.
  • In grades III and IV, surgery is required.
  • Doctors can detect and diagnose piles on examination.


A person with piles experiences the following symptoms:

  • Anus becomes itchy.
  • There is sometimes infection in the anus.
  • The anus gets red.
  • A hard and painful lump is felt around the anus.
  • Anal bleeding.
  • Red blood after the bowel movement.
  • Pain during passing stool.
  • The anus becomes sore.

It’s Causes

Piles are caused due to excessive pressure in the lower rectum. This pressure can lead to swelling in the tissues containing these dilated veins. These swollen anal cushions are referred to as piles.


In pregnancy, abdominal pressure is increased, and venous blood flow from the abdomen to the heart is slowed down. Hence, back pressure in the veins increases.

Chronic constipation:

This leads to straining, which in turn can cause wear and tear in the anal cushions.

Chronic diarrhea:

Constant straining, in this case, also leads to piles.

Lifting heavy weights:

This causes abdominal muscles to contract and hence the increase in abdominal pressure. This, in turn, leads to dilatation of veins.


When passing stool.

Piles grades

Piles are classified into the following four grades:

Grade I

In grade I, piles are present internally and are small size inflammations. They are inside the lining of the anus but not visible.

Grade II

In grade II, piles are present internally, but they are larger than the grade I piles. They are still inside the anus. They might be thrust at the time of a stool’s flow, but they are unaided at this stage.

Grade III

In grade III, piles are present externally, and they can be seen outside the anus. A person can feel and sense them hanging from the rectum. Grade III piles are also called prolapsed hemorrhoids.

Grade IV

In grade IV, piles are present externally and aren’t small enough to be present inside the anus. They remain outside the anus and need to be treated.


  • Eat high fiber food.
  • Soak the anal area with warm water.
  • Use wet toilet papers.
  • Keep the anal area clean.
  • Eat fruits and vegetables.
  • Don’t use dry tissues.
  • Apply soft creams for making the anus area soft.

The new treatment modalities

1. Rubber band ligation

In Rubber band ligation, the doctor takes a rubber band and puts it in the internal piles’ foundation.

Purpose of Rubber band ligation:

The purpose of Rubber band ligation is to cut off the supply of blood. The piles then shrink. Problems that occur after Rubber band ligation treatment:

  • Bleeding.
  • Extremely painful.
  • It can cause infections.
  • It might cause blood clots.

2. IRC (infrared coagulation)

Infrared coagulation is also called coagulation therapy. Infrared coagulation is for the patients having piles of grade I and grade II. This is one of the most effective and efficient nonsurgical treatments. This is used to treat small and medium-sized piles. This treatment is only for the internal piles.

Infrared coagulation has no side effects. This procedure is painless.

How does it work?

In Infrared coagulation, the doctor uses a device that induces an intense beam of infrared light. The heat induced by the infrared light produces a scarred tissue that basically drops the blood supply to piles. It is then removed or eliminated, but a scar is left behind on the anal canal.

Only one pile is treated at a time. Others will be treated with a gap of 14-15 day intervals.  During this procedure, you may feel a sort of heat and pain.

When is infrared coagulation helpful?

Infrared coagulation is helpful for the treatment of piles that are of small size.

Problems that occur because of Infrared coagulation treatment:

  • Pain during the procedure.
  • Bleeding from the anus.
  • Infection in the anal area.
  • Temporary urinary retention.

3. Electrocoagulation

This technique is similar to infrared coagulation, except that the doctor uses heat from the electric current instead of infrared light.

Purpose of Electrocoagulation

The purpose of using Electrocoagulation is to create a scarred tissue and then cut off the piles’ blood supply.

4. Laser

This is an advanced treatment for piles, i.e., laser treatment. Laser treatment is a less invasive treatment. The affected area is treated with laser energy in an exact and focused way.

How does it work?

In laser treatment, the laser is directed by the radical fiber in the submucosal tissue containing anal cushions, dilating. The laser energy also reduces blood supply reducing the nourishment of abnormal growth. Laser surgery also prevents the chances of getting a prolapse.

Benefits of using laser treatment

  • Less pain.
  • Reduce the risk of bleeding.
  • Recovery becomes faster.
  • The whole procedure is completed within half an hour.
  • It can be performed on the same day the patient visit clinic.
  • Comfortable procedure.
  • The patient gets a discharge on the same day.
  • There are no cuts, stitches, or wounds.

5. Sclerotherapy

In this Sclerotherapy, injection is given that puts and places chemicals in the pile’s tissue.

Purpose of Sclerotherapy

Sclerotherapy’s purpose is that the chemicals in the pile’s tissue drop the supply of blood to piles. It also shrinks piles.

It would help if you had this treatment every few weeks until they go away completely. With this treatment, piles might come after a few years.

6. Hemorrhoidectomy

This type of technique is effective and efficient, and it completely removes piles, but it might cause complications.

This procedure can be performed under various anesthesia forms, including general anesthesia, spinal anesthesia, local anesthesia with sedation.

Problems that might occur:

  • Difficulty in passing stool.
  • Painful procedure.
  • The problem in urinating.

7. Hemorrhoid stapling

In the Hemorrhoid stapling technique, the blood flow to piles tissue is stopped. This procedure is less painful as compared to the Hemorrhoidectomy technique.

Problems associated with this procedure involve mainly the issues with a recurrence of hemorrhoids and rectal prolapse. It is a condition in which part of the rectum protrudes out through the anus.


Piles can be problematic in one way or another and can affect daily life activities, varying from bleeding to pain. Treatment of piles is therefore necessary. There are several treatments available depending on the patient’s condition and the choice they are willing to make.

Inspired By: Medical News Today

Dr. Hafsa Akbar

I have a MBBS from King Edward Medical University and did my clinical training at Pakistan’s Mayo Hospital, one of the most prestigious medical institutions in South Asia. My passion for medicine led...

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