Haemorrhoids (Piles): UK Guide
2-minute consultation reviewed by a UK clinician
We check your answers and recommend a suitable option
Plain packaging to your door, fast and confidential
Haemorrhoids (Piles)
Causes, grading, symptoms, diagnosis and UK treatment — from self-care to banding and surgery.
Key fact: Haemorrhoids (piles) are among the most common conditions in the UK, affecting around 75% of people at some point in their lifetime. Despite how common they are, many people delay seeking help due to embarrassment. The majority of haemorrhoids resolve with simple self-care and dietary changes. Persistent or symptomatic haemorrhoids have effective treatment options at every stage, from topical medicines to outpatient procedures.
What Are Haemorrhoids?
Haemorrhoids are swollen, enlarged vascular cushions in and around the lower rectum and anal canal. All people have vascular cushions in this area — they are a normal part of anal anatomy, contributing to continence by helping to seal the anal canal. Haemorrhoids develop when these cushions become enlarged, inflamed or prolapsed.
Despite their reputation, haemorrhoids are not simply “varicose veins of the anus.” They are a distinct anatomical structure. Their development is influenced by straining, constipation, diet and genetic factors. They are classified by location (internal or external) and by severity (grade I–IV for internal haemorrhoids).
Internal vs External Haemorrhoids
| Type | Location | Key features | Pain? |
|---|---|---|---|
| Internal haemorrhoids | Above the dentate line, inside the rectum | Usually painless; bleed bright red; may prolapse through the anus; classified Grade I–IV | Usually painless (area above dentate line has no pain fibres) |
| External haemorrhoids | Below the dentate line, under the skin around the anus | Visible or palpable; itching; skin tags may persist after resolution; can thrombose acutely | Often uncomfortable; acutely thrombosed external haemorrhoids are very painful |
| Mixed haemorrhoids | Both internal and external components | Combined symptoms of both types; common in persistent or recurrent haemorrhoids | Variable |
Grading of Internal Haemorrhoids
| Grade | Description | Typical treatment |
|---|---|---|
| Grade I | Haemorrhoids bulge into the anal canal but do not prolapse through the anus | High-fibre diet; adequate fluids; topical treatments; rubber band ligation |
| Grade II | Prolapse through the anus on straining but reduce spontaneously | Rubber band ligation; sclerotherapy; high-fibre diet |
| Grade III | Prolapse through the anus and require manual reduction | Rubber band ligation (multiple sessions); haemorrhoidopexy; haemorrhoidectomy |
| Grade IV | Permanently prolapsed and cannot be reduced | Surgical haemorrhoidectomy; haemorrhoidopexy (stapled haemorrhoidopexy) |
Causes and Risk Factors
Chronic constipation and straining
The single most important modifiable risk factor. Straining at stool increases intra-abdominal and anorectal venous pressure, causing the vascular cushions to engorge and prolapse over time. Improving bowel habit and stool consistency is the cornerstone of haemorrhoid prevention and management.
Low-fibre diet
A diet low in fibre leads to hard, dry stools that require more straining to pass. Increasing dietary fibre to 25–30g per day softens stools and reduces straining. This alone resolves mild haemorrhoid symptoms in many people.
Pregnancy
Haemorrhoids are extremely common in pregnancy, particularly in the third trimester. The growing uterus compresses pelvic veins, increasing venous pressure in the anorectal region. Hormonal changes also relax vascular smooth muscle. Constipation in pregnancy further compounds the problem. Most pregnancy-related haemorrhoids resolve postpartum.
Prolonged sitting
Sitting for extended periods — particularly on the toilet — reduces venous return from the anorectal area. A common piece of advice is to avoid spending extended time on the toilet: defecate when the urge is present, then leave. Mobile phone use on the toilet is a modern contributor to prolonged sitting.
Obesity
Excess body weight increases intra-abdominal pressure chronically. Obesity is an independent risk factor for haemorrhoid development and for poor outcomes after treatment. Weight loss where appropriate reduces both the risk and severity of haemorrhoids.
Genetic predisposition
A family history of haemorrhoids increases personal risk, likely through inherited differences in vascular connective tissue strength and elasticity. Some individuals are more susceptible to vascular cushion prolapse regardless of lifestyle factors.
Symptoms
- Bright red rectal bleeding — usually noticed on tissue paper or in the toilet bowl after defecation; the most common symptom
- Itching and irritation around the anus — often caused by mucus discharge or skin tags
- A sensation of a lump or fullness at the anus — prolapsed internal haemorrhoid or external haemorrhoid
- Discomfort, aching or pain — particularly with external or thrombosed haemorrhoids; internal haemorrhoids are typically painless
- Mucus discharge after defecation
- A feeling of incomplete emptying after defecation
- Soiling of underwear if haemorrhoids are prolapsed and cannot maintain anal seal
Acutely thrombosed external haemorrhoid: Sudden development of a painful, tense, purple-blue lump at the anus is the presentation of an acutely thrombosed external haemorrhoid. This is very painful but not dangerous. Conservative management (ice packs, topical anaesthetics, analgesics, high-fibre diet) resolves most cases within 7–10 days. Surgical excision in the first 72 hours produces faster resolution but is rarely necessary.
Diagnosis
Haemorrhoids are usually diagnosed by history and clinical examination. A digital rectal examination (DRE) and proctoscopy (inspection of the lower rectum with a short rigid instrument) allows direct visualisation of internal haemorrhoids and confirmation of their grade.
Importantly, NICE and the BSG recommend that rectal bleeding should not be attributed to haemorrhoids without appropriate assessment, particularly in:
- Anyone aged 40 or over with rectal bleeding
- Anyone with dark or mixed blood (not purely bright red on tissue paper)
- Anyone with a change in bowel habit alongside bleeding
- Anyone with unexplained iron-deficiency anaemia
- Anyone with a personal or family history of bowel cancer or polyps
Self-Care and Dietary Changes
The majority of Grade I and II haemorrhoids, and many Grade III, respond to self-care measures. These should always be implemented regardless of whether medical treatment is also used:
- Increase dietary fibre to 25–30g per day — fruit, vegetables, wholegrains, beans and lentils; or a fibre supplement (ispaghula husk, e.g. Fybogel)
- Drink at least 1.5–2 litres of fluid per day to soften stools
- Do not strain at stool — if defecation is difficult, use a foot stool to raise the feet (squat position reduces anal canal pressure)
- Do not delay when you have the urge to defecate — ignoring the urge hardens stool
- Limit time on the toilet — avoid reading, using your phone, or sitting longer than needed
- Sitz baths — sitting in warm (not hot) shallow water for 10–15 minutes after bowel movements soothes anal discomfort and reduces swelling
- Keep the perianal area clean and dry — gently clean with unscented wipes or water; avoid vigorous wiping
- Avoid prolonged sitting generally — take regular short walks if your work is sedentary
Topical Treatments
Topical preparations provide symptomatic relief from pain, itching and inflammation but do not shrink or cure haemorrhoids. They are appropriate as short-term adjuncts to dietary and lifestyle measures.
| Product | Active ingredients | Best for | Duration limit |
|---|---|---|---|
| Anusol | Zinc oxide, bismuth subgallate | Mild itching and protection; OTC; suitable during pregnancy | No strict limit |
| Anusol HC | Hydrocortisone + zinc oxide | Inflammation and itching; prescription; more effective than plain Anusol for symptoms | 7 days maximum (steroid) |
| Proctosedyl | Hydrocortisone + cinchocaine (local anaesthetic) | Pain, burning and itching; prescription | 7 days maximum |
| Scheriproct | Prednisolone + cinchocaine | Moderate to severe symptoms; prescription; higher potency steroid | 7 days maximum |
| Xyloproct | Hydrocortisone + lidocaine + zinc oxide + aluminium acetate | Combined anti-inflammatory, anaesthetic and astringent; prescription | 7 days maximum |
Steroid-containing topical preparations should not be used for more than 7 days due to the risk of perianal skin thinning with prolonged use. They are for acute symptom relief only — dietary and lifestyle changes must accompany them to address the underlying cause.
Office-Based and Surgical Procedures
For haemorrhoids not responding to self-care and topical treatment, several procedures are available in increasing order of invasiveness:
- Rubber band ligation (RBL): Most effective office-based procedure for Grades I–III. A rubber band is placed around the base of the internal haemorrhoid, cutting off blood supply. The haemorrhoid shrinks and falls off within 5–10 days. Clearance rates 70–95% after 1–3 sessions. Minor post-procedure discomfort is common; significant pain is rare but requires urgent review.
- Sclerotherapy: Injection of phenol in oil into the base of the haemorrhoid causes fibrosis and reduction. Effective for Grade I–II bleeding haemorrhoids; less effective than banding for prolapse. Quick, painless procedure.
- Infrared coagulation: Infrared light applied to the haemorrhoid base causes tissue coagulation. Similar efficacy to sclerotherapy; appropriate for Grades I–II.
- Haemorrhoidectomy: Surgical excision under general or spinal anaesthetic; most effective and definitive treatment for Grade III–IV haemorrhoids. Longer recovery (2–4 weeks); post-operative pain is significant but well managed with analgesia. Recurrence rate <5%.
- Stapled haemorrhoidopexy (PPH): A circular stapling device repositions rather than excises the haemorrhoids. Less post-operative pain than conventional haemorrhoidectomy; higher long-term recurrence rate. Suitable for Grade III prolapsing haemorrhoids.
Haemorrhoids in Pregnancy
Haemorrhoids are very common in pregnancy, particularly in the third trimester and immediately postpartum. Most resolve spontaneously within weeks of delivery. Management is conservative in the first instance:
- High-fibre diet and adequate hydration to prevent constipation
- Plain topical preparations (Anusol without hydrocortisone) are safe in pregnancy
- Short-course steroid-containing preparations (maximum 7 days) can be used in the second and third trimester if symptoms are severe — discuss with your midwife or prescriber
- Sitz baths and cold compresses provide symptomatic relief
- Office procedures (banding, sclerotherapy) are generally avoided during pregnancy and reserved for the postnatal period if haemorrhoids persist
Get Haemorrhoid Treatment Online
Access Doctor provides prescription topical haemorrhoid treatments — including Anusol HC, Proctosedyl and Scheriproct — following a confidential online consultation with our GPhC-registered pharmacist independent prescribers. No GP appointment required.
View Haemorrhoid Treatments →When to Seek Help
- You have rectal bleeding that has not been assessed — do not assume it is haemorrhoids without clinical review
- Haemorrhoid symptoms are not improving after 2–4 weeks of self-care and dietary changes
- You develop a suddenly painful, swollen lump at the anus (thrombosed external haemorrhoid) — seek assessment within 72 hours if possible
- Prolapse requires manual reduction or cannot be reduced
- You are experiencing significant pain, heavy bleeding or anaemia
- You are pregnant and haemorrhoid symptoms are severe
Seek urgent medical assessment if you pass large amounts of blood, develop significant rectal pain with fever, or notice dark or tarry stools. Dark blood mixed with stool is not a typical feature of haemorrhoids and requires urgent investigation to exclude a more serious gastrointestinal cause.
Frequently Asked Questions
What are haemorrhoids?
Haemorrhoids are swollen vascular cushions in and around the lower rectum and anus. They are extremely common — affecting up to 75% of people at some point. They can be internal (inside the rectum, usually painless) or external (under the skin around the anus). Most resolve with self-care; persistent or symptomatic haemorrhoids have effective treatments at every stage.
What causes haemorrhoids?
Haemorrhoids develop when the vascular cushions lining the anal canal become enlarged and prolapsed. Key contributing factors are chronic constipation and straining, a low-fibre diet, pregnancy, prolonged sitting (especially on the toilet), obesity and genetic predisposition. Straining increases anorectal venous pressure, causing cushions to engorge over time.
What are the symptoms of haemorrhoids?
Bright red rectal bleeding (usually on tissue paper or in the bowl), itching and irritation around the anus, a feeling of a lump at the anus, discomfort or aching (particularly with external haemorrhoids), mucus discharge, and a feeling of incomplete emptying. Internal haemorrhoids are typically painless; external haemorrhoids can be uncomfortable.
Should I see a doctor about rectal bleeding?
Yes — any rectal bleeding should be assessed by a clinician, particularly in anyone aged 40+, anyone with dark or mixed blood, anyone with a change in bowel habit, or anyone with a family history of bowel cancer. Haemorrhoids are the most common cause of rectal bleeding but should not be assumed without appropriate assessment.
What topical treatments are available for haemorrhoids?
Topical preparations containing a local anaesthetic (cinchocaine, lidocaine) and corticosteroid (hydrocortisone, prednisolone) relieve pain, itching and inflammation. Products include Anusol HC, Proctosedyl and Scheriproct. They should be used for no more than 7 days due to the risk of skin thinning with prolonged steroid use.
What procedures treat haemorrhoids?
Rubber band ligation is the most effective office-based treatment for Grades I–III internal haemorrhoids, with 70–95% clearance rates. Sclerotherapy and infrared coagulation are alternatives for milder cases. Surgical haemorrhoidectomy is reserved for Grade III–IV or cases not responding to other treatments and has the lowest recurrence rate (<5%).
References
- National Institute for Health and Care Excellence (NICE). Haemorrhoids: Clinical Knowledge Summary. Updated 2023. cks.nice.org.uk/topics/haemorrhoids
- NHS. Piles (haemorrhoids). NHS.uk, 2023. nhs.uk/conditions/haemorrhoids-piles
- Association of Coloproctology of Great Britain and Ireland (ACPGBI). Guidelines for the management of haemorrhoidal disease. 2021.
- Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World Journal of Gastroenterology. 2012;18(17):2009–2017.
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.
