Piles (haemorrhoids): symptoms, causes and treatment

Piles are haemorrhoids. The two words name the same condition: blood vessels in and around the anus that have swollen, and that can bleed, itch, ache or slip out. Piles is the everyday word in the UK and many other English-speaking countries. Haemorrhoids is the medical term, spelled hemorrhoids in the US, which is why most of this site uses that spelling.

This page is the short, practical version for anyone who searched for piles: what they are, what the NHS advises, what a pharmacist can give you, and when to see a GP or go to A&E. Each section links to a longer guide. If you want the full picture under the medical name, start with hemorrhoids: what they are and how to get relief.

Piles, haemorrhoids and hemorrhoids: one condition

Everybody has soft cushions of blood vessels lining the anal canal. Doctors define haemorrhoids as those normal cushions becoming enlarged and slipping downward until they cause symptoms ¹⁴. That is what people mean when they say they have piles. The NHS describes piles as swollen blood vessels and notes that it is not clear exactly what causes them ¹.

Piles are very common. A 2026 review of piles worldwide pooled 150 studies with almost 9 million people and put the worldwide prevalence at about 26 percent at any one time ². In a screening study of 976 adults having a colonoscopy, 39 percent had haemorrhoids, and more than half of those had no symptoms at all ³.

If you are reading guides from different countries, these words mean the same thing:

Symptoms of piles

The NHS lists these as the main symptoms of piles ¹:

• bright red blood after you poo
• an itchy anus
• mucus in your underwear or on toilet paper after wiping
• pain around your anus

Some people also feel a lump at the edge of the anus, or something that slips out when they poo and goes back in. Internal piles, higher up inside the anus, tend to bleed without much pain. External piles, under the skin at the edge, are the ones that itch, ache and sometimes form a painful clot. The differences, and the 1 to 4 grading doctors use, are explained in internal hemorrhoids and external hemorrhoids. What each symptom means is covered in hemorrhoid symptoms.

What causes piles?

The NHS says piles are more likely with ¹:

• constipation
• pushing too hard when pooing
• heavy lifting
• pregnancy
• getting older
• being overweight

The 2026 prevalence review found piles linked with older age, obesity, pregnancy, diabetes, constipation and a family history, in analyses that did not adjust for other factors ². The studies behind each cause are in what causes hemorrhoids.

How to treat piles at home

The NHS advice on piles for self-care is short ¹:

Fibre has the strongest evidence of any home treatment. A meta-analysis of seven fibre trials found that fibre lowered the chance of bleeding by 50 percent and the chance of symptoms persisting by 47 percent ⁵. Water helps it work: in adults with constipation who already ate about 25 grams of fibre, drinking about 2 litres a day raised stool frequency more than drinking about 1 litre ⁶.

A warm bath is the other standard step. Sitting in warm water at 40°C lowered resting pressure in the anal muscle in a lab study, which eases spasm pain ¹². A cold pack wrapped in a towel helps swelling. Step-by-step plans for the first 48 hours are in how to get rid of hemorrhoids fast, and fibre, plant pills, soaks and oils are graded in natural remedies for hemorrhoids.

What a pharmacist can give you for piles

The NHS says a pharmacist can suggest creams to ease pain, itching and swelling, laxatives if you are constipated, and cold packs ¹. Most pile creams fall into a few groups: numbing creams, astringents such as witch hazel, soothing barrier creams, and creams with a mild steroid such as hydrocortisone ⁸.

Hydrocortisone creams, ointments and suppositories for piles should not be used for more than 7 days unless a doctor tells you to ⁷. A 2026 expert review of haemorrhoid treatment says topical creams of all kinds can be considered, and that there is little data showing they work ⁸. Treat a cream as comfort for a few days while the fibre and fluids do the main job.

Flavonoid tablets such as diosmin are another option. A Cochrane review of 20 trials found they reduced bleeding and itching, with weak trial methods ¹¹. More is in diosmin for hemorrhoids. Creams sold on Amazon in the US are compared on the best hemorrhoid creams.

When to see a GP about piles

The NHS advises seeing a GP if ¹:

• your symptoms are getting worse, or there is no improvement after trying treatments at home
• you keep getting piles
• you notice a change around your anus that is not normal for you

A GP can prescribe stronger medicines for piles or constipation ¹. NIDDK, the US government digestive health institute, gives a similar timeline: see a doctor if symptoms are no better after a week of home treatment ⁹. In the US, bowel cancer screening starts at 45 for adults at average risk ¹³. New bleeding from the bottom should be looked at, even if you are fairly sure it is piles.

The urgent signs above come from the NHS piles page ¹. More detail on what happens at an appointment is in when to see a doctor for hemorrhoids.

Hospital treatments for piles

If home treatment has not worked, a GP can refer you to a hospital clinic. The NHS lists four main treatments ¹:

The European Society of Coloproctology guideline for haemorrhoidal disease sets out which of these suits which grade of pile, from basic treatment through office procedures to surgery ⁴. The NHS notes that treatment does not always stop piles coming back ¹. How each procedure compares on pain, recovery and recurrence is in hemorrhoid procedures, and banding is walked through in rubber band ligation: what to expect.

Piles in pregnancy

Piles are common in pregnancy and after giving birth. The NHS pregnancy advice is to eat plenty of fibre and drink water, take regular exercise, avoid long spells of standing or sitting, avoid straining, clean with moist toilet paper and pat rather than rub, and hold a cloth wrung out in iced water against painful piles ¹⁰. It says not to use a cream or medicine without checking with your doctor, midwife or pharmacist first ¹⁰. The full plan, including which treatments are considered safe, is in hemorrhoids during pregnancy and postpartum hemorrhoids.

Piles or something else?

Several other problems feel like piles. A sharp, tearing pain when you poo, followed by burning that lasts hours, sounds more like an anal fissure; see hemorrhoid or anal fissure. A soft, painless flap of skin that stays after a flare is usually an anal skin tag, covered in anal skin tags. An itch with no lump or bleeding often has other causes, explained in itchy anus. If you are unsure, the hemorrhoid symptom checker asks a few questions and points you to the right page.