Piles (Haemorrhoids): Symptoms, Home Care, When to Worry

What this article covers

What are piles, and how do I know if I have them?
Internal or external piles: what the difference looks and feels like
Why do piles happen? Straining, constipation and your phone
How to treat piles at home: the steps that actually work
Piles creams, suppositories and tablets: what the pharmacy can offer
Rectal bleeding after 40: why you should never assume it is just piles
Banding, injections or surgery: which treatment is right for piles?
Piles in pregnancy and after childbirth
Why people wait too long, and when to see a doctor about piles

What are piles, and how do I know if I have them?

Piles, or haemorrhoids, are swollen blood vessels in the lining of the anus and the lower rectum. Everyone has these cushions of tissue, because they help seal the back passage. They become piles when they stretch, swell and start causing symptoms, usually after months of straining, constipation or long periods sitting on the toilet.

The classic signs are bright red blood on the toilet paper or dripping into the pan after you pass a stool, itching or soreness around the anus, a feeling that you have not fully emptied your bowel, and a soft lump that you can feel at the opening. Some people notice mucus on their underwear. Many people with piles have only one of these symptoms.

Piles are common, uncomfortable and almost never dangerous in themselves. In a 2024 survey of 400 adults in Makkah, 16 percent said they had been diagnosed with piles, and the most common complaints were pain on opening the bowels, general discomfort and swelling. The real risk is not the piles but assuming that every episode of bleeding is piles, which this guide covers in detail below.

Internal or external piles: what the difference looks and feels like

Internal piles start inside the rectum, above a line where the skin has very few pain nerves. That is why they usually bleed without hurting. The blood is bright red, appears after a bowel movement, and sits on the paper or on the surface of the stool rather than mixed through it. Doctors grade internal piles from one to four depending on whether they stay inside, slip out and go back by themselves, need to be pushed back, or stay outside all the time.

External piles form under the skin around the opening of the anus, where there are many pain nerves. They itch, feel swollen and make wiping uncomfortable. If a clot forms inside one, called a thrombosed pile, you suddenly get a hard, purple or bluish lump that can be very painful for several days. A doctor can sometimes remove the clot through a small cut in the first few days, which brings fast relief.

Other conditions can feel like piles. An anal fissure, a small tear in the skin of the anus, causes a sharp cutting pain while passing a hard stool and often a burning ache for an hour afterwards. An abscess causes a throbbing, worsening pain with fever. Skin tags are soft, painless flaps of skin left after an old pile has healed. Telling these apart needs an examination, which takes a few minutes in a clinic.

Telling the common causes apart

Condition	Pain	Bleeding	Typical feel
Internal piles	Usually none	Bright red, after the stool	Fullness, a lump that may slip out
External piles	Soreness, itching	Sometimes, small amounts	Soft swelling at the opening
Thrombosed pile	Sudden and severe	Rarely, unless it bursts	Hard purple or blue lump
Anal fissure	Sharp, cutting, during the stool	Small streak on the paper	Burning that lasts after the toilet
Anal abscess	Throbbing, getting worse	Pus more than blood	Hot, tender swelling, often fever

Why do piles happen? Straining, constipation and your phone

Anything that raises pressure in the veins of the back passage for long periods can cause piles. The biggest culprit is constipation, because hard stools mean straining, and straining pushes blood into the cushions. Chronic diarrhoea irritates the area in a similar way. Heavy lifting at work, a long-standing cough, excess weight and getting older, as the supporting tissue weakens, all add to the risk.

Diet in much of the region works against your bowel. Meals built on white bread, white rice and meat, with few vegetables, pulses and whole grains, and too little water in a hot climate, produce small, hard stools. The Makkah study found that piles were more common in people who ate a low-fibre diet, in people who were overweight, and in married women who had been pregnant. Long hours sitting, whether behind a desk or driving a taxi, also play a part.

Time on the toilet matters too. A 2025 study of 125 adults having a colonoscopy in Boston found that two thirds used their smartphones on the toilet, that phone users were far more likely to sit there for more than five minutes, and that phone use was linked to a 46 percent higher risk of piles even after accounting for fibre intake and straining. Sitting on an open toilet seat lets the cushions hang and fill with blood, so the habit of scrolling while you wait is worth breaking.

What regional and recent research shows

16% of adults surveyed in Makkah had been diagnosed with piles

46% higher risk of piles linked to smartphone use on the toilet

66.7% of Makkah residents who never sought help said embarrassment stopped them

Source: Al-Masoudi et al, Cureus 2024; Ramprasad et al, PLoS One 2025; Salih et al, Cureus 2024

How to treat piles at home: the steps that actually work

The aim of home care is simple: soft, easy stools that pass without straining. Fibre is the foundation, and it has the best evidence of any home treatment. A review of seven clinical trials with 378 patients found that taking fibre cut the risk of persistent symptoms by about 47 percent and the risk of bleeding by about half, with the benefit lasting over three months of follow-up. Lentils, chickpeas, ful, freekeh, bulgur, oats, vegetables and fruit such as figs, dates and pears are all good sources.

Increase fibre gradually over a couple of weeks, because a sudden jump causes wind and bloating. Drink enough water that your urine stays pale, especially in summer and during Ramadan, when the hours between iftar and suhoor are the only chance to catch up. A fibre supplement such as psyllium husk, sold in pharmacies and also known locally as ispaghula, is an option if your diet cannot change quickly enough.

Change the way you use the toilet. Go when you feel the urge rather than holding it, leave your phone outside, and get up after a few minutes if nothing is happening. If you use a Western toilet, resting your feet on a small stool raises your knees and straightens the passage, much like the squatting toilets common in older homes. Wash gently with water rather than rubbing with dry paper, and pat the area dry.

Warm sitz baths ease pain and itching. Sit in a basin or bath of plain warm water, enough to cover your bottom, for ten to fifteen minutes two or three times a day and after bowel movements. You do not need to add salt, herbs or antiseptics. A cold pack wrapped in a cloth can calm a swollen external pile for a few minutes at a time.

A daily routine for piles

1Add one fibre-rich food to every meal, such as lentils, oats, vegetables or fruit, and build up slowly
2Drink water through the day so your urine stays pale
3Go to the toilet when you feel the urge, and do not hold it in
4Leave your phone outside and keep toilet visits to a few minutes
5Raise your feet on a small stool if you use a Western toilet
6Wash with water and pat dry instead of rubbing with paper
7Sit in warm water for ten to fifteen minutes after bowel movements

Piles creams, suppositories and tablets: what the pharmacy can offer

Pharmacies across the region sell piles creams, ointments and suppositories without a prescription. Most contain one or more of three things: a soothing barrier, a local anaesthetic such as lidocaine that numbs the area for a few hours, or a mild steroid such as hydrocortisone that reduces swelling and itching. These products relieve symptoms while the home measures do the real work. They do not shrink a pile permanently.

Steroid creams are meant for short courses, usually no more than about a week unless a doctor advises otherwise. Used for weeks or months, they thin the delicate skin around the anus, which then tears and itches more easily, starting a cycle of using more cream. Read the label, and if your symptoms have not improved after a week of careful use, that is the moment to see a doctor rather than buy a stronger tube.

Tablets that act on the veins, often containing flavonoids such as diosmin, are widely sold in the region and many people take them during a flare. Some studies suggest they can ease bleeding in the short term, but they do not replace fibre and better toilet habits. Mention them to your doctor or pharmacist, especially if you are pregnant or take other medicines.

Be very careful with traditional remedies. Garlic, salt, alum, raw onion or herbal pastes from the attar can burn the thin skin of the anus and cause ulcers and infection. Never push anything inside the back passage that was not made for that purpose, and never use a product a friend recommended for their own piles if you have not been checked first.

Rectal bleeding after 40: why you should never assume it is just piles

Bowel cancer and large polyps can bleed in exactly the same way as piles, and the two can exist together. The only way to tell them apart is an examination and, when needed, a camera test of the bowel called a colonoscopy. This is the single most important message in this guide, because people in the region often treat bleeding themselves for months before anyone looks.

Bowel cancer is no longer only a disease of the elderly. A 2023 study of 286 people diagnosed under the age of 50 in the United States found that 53 percent had rectal bleeding, 54 percent had a change in bowel habit and that more than half had symptoms for at least three months before diagnosis, by which time most cancers were advanced. A 2024 review of bowel cancer in Saudi Arabia notes that national guidance now recommends screening for everyone from age 45.

So if you are over 40, if you have a parent, brother or sister who had bowel cancer, or if the bleeding comes with any of the warning signs below, book a medical review rather than another pharmacy cream. Bleeding that is dark red, maroon or black, or blood that is mixed into the stool rather than sitting on the surface, comes from higher up and is never typical of piles. Tiredness and breathlessness can mean that slow bleeding has caused anaemia, which a simple blood count can show.

Banding, injections or surgery: which treatment is right for piles?

If piles keep bleeding or slipping out despite good home care, a surgeon or gastroenterologist can treat them in clinic. The most widely used procedure is rubber band ligation, or banding. A small elastic band is placed around the base of an internal pile through a short tube. The pile loses its blood supply and falls off within about a week, usually unnoticed in a bowel movement. It takes a few minutes, needs no anaesthetic, and you go home the same day.

Other clinic options include injecting a solution that shrinks the pile, called sclerotherapy, and sealing it with heat or infrared light. These suit smaller internal piles. For large piles that stay outside, or those that return after banding, the usual operation is a haemorrhoidectomy, in which the piles are cut away under anaesthetic. Stapling and ultrasound-guided stitching of the feeding artery are alternatives offered in some centres.

A 2021 review of eight randomised trials comparing banding with surgery for grade two and three piles found that surgery controlled symptoms better, but banding caused less pain, had fewer complications such as bleeding and difficulty passing urine, and let people return to work sooner. Satisfaction was similar in both groups. In practice, many specialists offer banding first and keep surgery for piles that do not respond. External piles cannot be banded because the skin there is full of pain nerves.

Comparing the main treatments

Treatment	Best for	Recovery	Main drawback
Banding	Grade 1 to 3 internal piles	A dull ache for a day or two	May need repeating
Injection or heat	Small bleeding internal piles	Usually back to normal next day	Piles return more often
Haemorrhoidectomy	Large or grade 4 piles, or failed banding	Often two to four weeks of pain	Most painful option, small risk of complications
Clot removal	A thrombosed external pile in its first days	Quick relief within days	Only useful early on

Piles in pregnancy and after childbirth

Piles are especially common in pregnancy. Hormones relax the walls of the veins, the growing womb presses on the veins of the pelvis, and constipation becomes more likely, particularly when iron tablets are added. The pushing of labour adds a final strain. The Makkah study above found that women who had been pregnant were among those most likely to report piles, and constipation is the factor that most often tips a pregnant woman into symptoms.

The good news is that pregnancy piles often settle on their own within weeks of delivery. The same home measures apply: more fibre, plenty of water, gentle walking, not straining and warm sitz baths. Lying on your left side for a while during the day takes some pressure off the pelvic veins. Pushing during labour can cause a painful clot in an external pile in the first days after birth, which is worth showing to your midwife or doctor.

Check with your doctor or pharmacist before using any cream, suppository or tablet while pregnant or breastfeeding, including the vein tablets sold over the counter. Bleeding in pregnancy should always be reported so that it can be checked properly, because not all bleeding from below in pregnancy is from piles.

Why people wait too long, and when to see a doctor about piles

Embarrassment keeps many people away from the clinic. In a 2024 survey of 495 adults in the Makkah region, almost four in five had poor knowledge about piles, and among those who had symptoms but never sought help, two thirds said embarrassment was the reason. That delay is what lets a simple problem become painful and lets a serious one go unnoticed. Doctors examine the back passage every working day, and the check takes minutes.

See a doctor if your piles have not improved after a week of good home care, if you bleed repeatedly, if the pain stops you sitting or working, or if you are not sure that what you have is piles at all. If you would feel more comfortable with a doctor of your own sex, it is reasonable to ask for one when you book.

A typical examination involves a look at the outside of the anus and a gentle check with a gloved finger, sometimes followed by a short look inside through a small tube called a proctoscope. Depending on your age and symptoms, the doctor may ask for a blood count or refer you for a colonoscopy. None of this is a sign that something is wrong. It is simply how bleeding is investigated properly.

In the Sihtak app you can keep a simple diary of bleeding, pain and bowel habits, so you can show your doctor a clear picture instead of trying to remember. The health assistant can explain your blood count results in plain language and remind you of the warning signs that mean you should not wait. It supports your care and does not replace an examination.

Frequently asked questions

Do piles go away on their own?

Many small piles settle within a few days to a couple of weeks once stools become softer and you stop straining. Piles that keep coming back usually need a change in diet and toilet habits to stay away. If they persist despite good home care, a doctor can offer banding or other treatments.

Is bright red blood on the toilet paper always piles?

Bright red blood on the paper is typical of piles or a small tear, but it is not proof. Bowel polyps and cancer can bleed in a similar way, especially in people over 40. Any new bleeding at that age, or bleeding with weight loss or a change in bowel habit, should be checked by a doctor.

Can I use a steroid piles cream for a long time?

Steroid creams are meant for short courses, usually up to about a week unless a doctor advises longer. Long use thins the skin around the anus and can make itching and tearing worse. If you still need cream after a week, see a doctor rather than continuing.

Does sitting on cold surfaces cause piles?

There is no good evidence that sitting on a cold floor or stone causes piles. What matters is pressure in the veins from straining, constipation, long toilet sitting and heavy lifting. Long hours sitting in general may add to the risk.

Is banding for piles painful?

Banding is usually done in clinic without anaesthetic, and most people feel a dull ache or pressure for a day or two afterwards. Severe pain after banding is unusual and should be reported to the doctor who did it. Many people return to normal activities the same or the next day.

Are piles a sign of cancer?

Piles are not cancer and do not turn into cancer. The concern is that bowel cancer can cause the same bleeding, so the two can be confused. That is why new bleeding after 40, or bleeding with warning signs, needs a proper examination.

Can I treat piles during pregnancy?

Yes, home measures such as more fibre, more water, avoiding straining and warm sitz baths are safe and effective in pregnancy. Ask your doctor or pharmacist before using any cream, suppository or tablet. Most pregnancy piles improve within weeks of giving birth.

Sources

This content is for health education only and is not a substitute for medical advice. If you have symptoms that worry you, see your doctor.