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Causes, symptoms and treatments for haemorrhoids (piles)

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Haemorrhoids, more commonly known as piles, are said to affect at least 50% of people at some point in their lives. Whilst haemorrhoids are not usually classed as a serious condition, they can be extremely uncomfortable and sometimes require further medical treatment, along with a change in diet and lifestyle. The uncomfortable symptoms associated with haemorrhoids can be successfully avoided by using effective treatment. Below we provide some medical information in regards to the condition, how it is caused, its associated symptoms and how to treat and/or prevent it.

If you do have haemorrhoids/piles and require treatment, we provide clinically proven prescription medication to treat the condition. All that you need to do is complete the simple online consultation that is assessed by one of our registered GPs, you are then recommended the best treatment suitable for you. Alternatively you can find out more about the condition below.

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What are haemorrhoids (piles)?

Haemorrhoids (or hemorrhoids) and commonly known as piles – can occur when the structures that line the anal canal become inflamed. These are vascular structures rich in blood vessels that can become easily irritated, especially with certain symptoms. Haemorrhoids do intend to occur internally, although the inflamed parts can push their way out of the anal opening, making the condition very painful. External haemorrhoids, on the other hand, are blood clots that form around the edge of the opening, and are rare in comparison.

Often, haemorrhoids – more commonly known as piles - can go away on their own, however if you have experienced symptoms lasting beyond 7 days it is advised to seek treatment. If you're prone to haemorrhoids, it is advised to have treatment stocked up, just in case an outbreak arises.

Types of haemorrhoids

Internal haemorrhoids

Most people who have haemorrhoids have the internal kind; these are swellings that occur 2 to 4cm above the anal opening, but they can prolapse. Haemorrhoids can be classed into first, second, third and fourth degree.

These swollen blood vessels usually rest inside the anal cavity, therefore you can't see or feel them. Due to the lowered pain nerves in the rectum it might not be sensed by the individual with haemorrhoids, with bleeding being the only indication that it is there. There are certain times where an internal haemorrhoid prolapses and then appears outside the anal sphincter. They can be described as moist skin tags with a pinker appearance compared to the skin around it.

Prolapsed internal haemorrhoids are usually more irritated and will be more painful than those that remain internally as they are more likely to rub against clothing or when passing stool. With time they usually retract back into the anal passage, if not then they can either be pushed back in gently or surgically removed. There are four grades of internal haemorrhoids, these include:


First-degree internal haemorrhoids are swellings of the internal lining that are not visible. Second-degree swellings are larger and may come out of the anus when passing stools and then move back in again. Third degree haemorrhoids are small lumps that hang out from the anal opening, but can be pushed back in again after passing stools while those classed as fourth degree are large external lumps that can be pushed back in.

External haemorrhoids

Perianal haematoma (external haemorrhoids) are very rare and is when the ridge of the anus becomes inflamed as a result of blood clots beneath the surface of the skin. Although these may sometimes get confused with prolapsed internal haemorrhoids, external haemorrhoids in fact are more rare than internal piles and are formed just outside the anal sphincter. Due to the heightened sensory glands present in this type of piles, they are likely to be more irritated and painful compared to internal haemorrhoids.

Causes of haemorrhoids (piles)

While the exact cause of haemorrhoids (piles) isn't clear, according to the NHS, most cases are thought to be linked to increased pressure in blood vessels that are located in and around the anus. This pressure causes the blood vessels within your back passage to become inflamed and swollen. Other factors that can increase the risk of getting haemorrhoids include:

  • pelvic blood vessels Pregnancy – increasing pressure on pelvic blood vessels
  • obesity Being overweight, or dealing with obesity
  • periods of time Sitting down for prolonged periods of time
  • Chronic Chronic diarrhoea or constipation
  • Increased age Increased age
  • objects regularly Lifting heavy objects regularly

Piles and constipation

Piles can be the result of a number of different factors, but it's most commonly associated with constipation. This is because constipated bowels can place additional pressure on the vascular structures that line the rectum, causing them to swell when you strain during a bowel movement.

If you have developed piles before, you can be more susceptible to develop them again due to recurring risk factors and/or simply being genetically more likely to develop symptoms, as well as having a hereditary connection.

Is it true that sitting on cold surfaces gives you piles?

No, this is a very common myth. Piles are the result of pressure and strain placed on blood vessels that line the back passage. This can cause them to stretch and swell so that they become pathological.

Symptoms of haemorrhoids

Many times people aren't even aware that they have piles, because they experience no symptoms, however, if symptoms are experienced, they may include:

  • symptoms Stool with blood
  • symptoms Anal itching
  • symptoms Sore and inflamed anus
  • symptoms Discharge of mucus after passing stools

These symptoms can also be caused by other colorectal problems such as anal cancer, bowel disease or bowel cancer, which is why it is important that you visit your GP if any of these symptoms persist for a constant period.[2]

Benefits of treating haemorrhoids

There are a number of benefits that can be experienced when you successfully treat haemorrhoids. These include:

  • Reduced pain and swelling

  • Easier passing of stool

  • Relieved itchiness and irritation

  • Easy to use prescription treatments

How to treat haemorrhoids

Treatment for haemorrhoids will depend on the severity and the persistence of the symptoms.

Prescription medication

If diet and exercise aren't helping, and your haemorrhoids aren't severe, you may be recommended a prescription for over the counter treatments designed to help provide immediate symptomatic relief and to help reduce inflammation. These types of treatments can either be suppositories, ointments, gels or sprays. The prescription options include:

As effective as these medications are, to get the best out of your treatment, it's advised that you use one of these treatments alongside appropriate dietary changes.


Most of the time swelling will go down on its own, or with the help of dietary changes, such as increasing fibre and fluids to keep stools soft. Drinking more water and avoiding caffeine can also help. A doctor is likely to recommend a more fibrous diet, more fluid, exercise or laxatives first, before recommending more intensive treatment. Therefore, dieting is a good first step in your treatment, but won't treat haemorrhoids completely on it's own.

Surgical measures

If diet and treatment weren't able to produce results, other more hands-on measures may be explored, this is rare and mostly happens in the case of third degree swellings. Majority of these do not require any invasive surgical intervention and can be done at an outpatient service, these could include:

  • Banding- this process involves the haemorrhoid being tied off at its base. This prevents blood flow thereby causing shrinkage and death of the haemorrhoid with it falling off after a short while. This procedure is usually done for internal haemorrhoids
  • Injections (sclerotherapy)- a chemical, oily solution is injected into the haemorrhoids, this causes the area to be numb reducing any pain symptoms, the haemorrhoid tissue is also hardened and should shrivel up within weeks.
  • Infrared coagulation- this procedure treats small or medium sized haemorrhoids and occurs when a device with an intense infra-red beam cuts of the blood supply to the haemorrhoid causing it to die and fall off within a few weeks.

These methods are only necessary in severe cases, and often, third degree swellings can shrink and become symptom-free without the use of these methods.

Prevention for haemorrhoids (piles)

Haemorrhoids can't always directly be prevented, but avoiding constipation and ensuring that stools are soft and regular can significantly minimise the risk. You can do this by employing the following steps:

  • Consuming a diet that is rich in fibre
  • Drinking plenty of fluids (preferably water)
  • Minimise caffeine and alcohol consumption.
  • Staying physically active can also ensure that your bowels remain healthy.
  • If you are currently overweight, you may also want to consider losing weight, as this can also be helpful

Reducing the amount of straining when passing stool can also help in preventing inflammation of the anal walls.

What treatment options do we offer?

If you are experiencing the uncomfortable symptoms associated with haemorrhoids, treatments are available to relieve them. These treatments consist of ointments and creams, all of which are approved by UK registered doctors. Treatments such as Anusol HC, Betnovate and Proctosedyl are clinically proven to aid swelling and speed up the healing process significantly. Ordering one of these treatments is quite simple and can be done by completing our discreet online consultation, where our UK registered doctors can decide if the treatment is right for you.


Dr Hilary Jones, HealthExpress Medical Advisor

How can I get help with my haemorrhoids?

Haemorrhoids can be very uncomfortable, and sometimes they will require treatment to alleviate the painful symptoms.

Click here to get prescription Haemorrhoids treatment