Haemorrhoids, or piles, are swollen blood vessels in and around the anus. Almost everyone has some haemorrhoidal tissue. It becomes a problem when it swells, bleeds or slips out (prolapses). They are very common and are not dangerous, but they can be uncomfortable and worrying.
Types
- Internal haemorrhoids lie inside the back passage. They are usually painless but may bleed or prolapse during a bowel movement.
- External haemorrhoids lie under the skin around the anus. They can itch, and can become suddenly painful and swollen if a blood clot forms (a thrombosed haemorrhoid).
Common symptoms
- Bright red blood on the toilet paper, dripping into the bowl or on the surface of the stool
- A lump at the anus, which may go back in on its own or need to be pushed back
- Itching, irritation or a feeling of incomplete emptying
- Pain, mainly with a clotted external haemorrhoid or a tear (anal fissure)
Common causes
- Constipation and straining
- Sitting on the toilet for a long time, such as using a phone
- Long-standing diarrhoea
- Pregnancy
- Heavy lifting and a low-fibre diet
Do not assume bleeding is from piles
Bleeding from the back passage has many causes, including polyps, inflammation and colorectal cancer, which can bleed in the same way. A short examination of the anus and lower bowel is usually done first. Depending on your age, a colonoscopy may be advised. It is also advised if the bleeding is new or keeps coming back, or if there are other warning signs:
- A change in bowel habit lasting more than a few weeks
- Dark blood, or blood mixed into the stool
- Unintended weight loss
- Anaemia or low iron (see iron deficiency anaemia)
- A family history of colorectal cancer (see colorectal cancer screening)
Treatment
- Softer, easier stools: more fibre from vegetables, fruit and whole grains, a fibre supplement if needed, and enough fluids
- Toilet habits: go when you feel the urge, avoid straining, and limit time on the toilet to a few minutes
- Short-term relief: warm sitz baths, and creams or suppositories for a few days at a time. Flavonoid tablets are sometimes used for flare-ups.
- Rubber band ligation: for internal haemorrhoids that keep bleeding or prolapsing, a small rubber band is placed at the base. The haemorrhoid shrinks and falls off over about a week. It is done without a general anaesthetic.
- HET (haemorrhoid energy therapy): a gentle heat treatment, applied with a small clamp, that shrinks internal haemorrhoids and reduces bleeding without cutting. It is used for small to moderate internal haemorrhoids, and is applied above the sensitive skin of the anus, so it usually causes little pain.
- Dr Chia performs both rubber band ligation and HET.
- Surgery: for large haemorrhoids that stay outside or do not respond to other treatment, a referral to a colorectal surgeon is arranged.
Seek urgent care at an emergency department for heavy bleeding, bleeding with dizziness or fainting, or severe pain with a fever.
General information only. Reviewed by Dr Chia Chung King, 2026-11-07. Book a consultation.