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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. Piles are recognised from your symptoms and treated by video; bleeding that needs a bowel examination, and banding or surgery, are in person.
- What they are: swollen blood vessels inside and around the bottom. Everyone has these cushions of blood vessels; they cause symptoms only when they swell.
- How common: about half of adults over 50 have piles, and in one screening study 55% of the people found to have them had no symptoms.
- How long they last: they often get better on their own after a few days. See a doctor if 7 days of home treatment have not helped.
- Emergency: call 112 for bleeding from the bottom that will not stop, a lot of blood or large clots, black, tar-like poo, or severe pain.
Do not book a video appointment if you are bleeding non-stop from the bottom, passing a lot of blood or large clots, feel dizzy or faint, have black, tar-like poo, or are in severe pain. Call 112 or go to an emergency department.
Can an online doctor treat piles?
Yes. Piles are usually recognised from your symptoms, and a doctor can assess them by video, ease the pain and itching, treat constipation, and prescribe stronger creams when they would help. You choose what you show on camera. Bleeding that needs a bowel examination, a lump that needs checking, and piles that keep coming back need in-person care, and the doctor tells you where to go.
How an online consultation helps with piles
- Piles, or something else?: A fissure, a fistula or a skin problem can feel similar, and the pattern of your symptoms helps tell them apart.
- Relief that suits you: Creams for pain, itching and swelling, and the right laxative, chosen after the doctor checks your other medicines.
- Bleeding taken seriously: Which bleeding fits piles, and when it needs a bowel examination to rule out other causes.
- A plan to stop them coming back: Fibre, fluids and toilet habits, and when banding or another procedure is worth considering.
What the doctor checks in an online piles consultation
The doctor asks about the warning signs first, then about the piles themselves. The doctor asks about:
- Warning signs: heavy or non-stop bleeding, black or dark red poo, dizziness, severe pain, or a high temperature with pus.
- The bleeding: bright red blood on the paper or in the pan, or blood mixed into the poo.
- The lump: whether it goes back inside on its own, needs pushing back, or is hard and very painful.
- Your bowels: constipation, straining, diarrhoea, and any change from your usual pattern.
- Other symptoms: weight loss, tiredness, or pain or a lump in your tummy.
- Your health: pregnancy, earlier bowel tests, bowel cancer in the family, and your medicines, including blood thinners.
Before the call, find a private space. You choose what you show on camera, and the doctor tells you if an examination in person would help.
What are piles, and what do they look like?
Piles are swollen blood vessels inside and around the bottom. Everyone has cushions of blood vessels in the anal canal, which help keep the bottom closed; they cause symptoms only when they swell. It is not clear exactly why they swell, but increased pressure in the lower bowel, from straining for example, plays a part.
Swipe sideways to compare →
| Type | Where | What you notice | What it looks like |
|---|---|---|---|
| Internal | Inside the bottom | Painless, bright red bleeding; the pile may come out during a poo | Usually cannot be seen; a soft, pink bulge when it comes out |
| External | Under the skin around the opening | Itching, discomfort, swelling, sometimes bleeding | Lumps from the size of a pea to the size of a grape, pink or purple |
| Thrombosed | A blood clot in an external pile | Sudden, severe pain and swelling | A hard, dark blue or purple lump |
The four grades of internal piles
Doctors grade internal piles by how far they come out:
- Grade 1: they bulge inside the anal canal but do not come out.
- Grade 2: they come out during a poo and go back in on their own.
- Grade 3: they come out and have to be pushed back in.
- Grade 4: they stay out and cannot be pushed back.
The lower the grade, the more likely a simple procedure such as banding is to work. Grade 3 and 4 piles, and piles that keep coming back, are more often treated with surgery.
What are the symptoms of piles?
The most common symptom is bright red blood after a poo, on the toilet paper or in the pan. Other symptoms are:
- an itchy bottom
- a lump around the bottom, or one that comes out after a poo
- pain or discomfort around the bottom, especially when sitting
- mucus in your underwear or on the toilet paper
- feeling that you still need to poo after going
Internal piles are usually painless. Severe pain points to a blood clot in an external pile, or to another cause such as an anal fissure. Many people with piles have no symptoms at all.
What does bleeding from piles look like?
Bright red blood on the toilet paper, red streaks on the outside of the poo, or pink water in the toilet bowl, usually in small amounts. Very dark or black poo points to bleeding higher up, from the stomach or bowel, and dark red poo or bloody diarrhoea needs urgent medical advice. Iron tablets and foods such as beetroot, liquorice and blueberries can change the colour of poo without any bleeding.
Can piles cause diarrhoea or mucus?
Diarrhoea is not a symptom of piles, but long-lasting diarrhoea can cause them. Mucus is a common symptom: keep the area clean and dry, treat constipation, and see a doctor if it continues.
What causes piles, and who gets them?
Piles form when pressure in the lower bowel makes the blood vessels swell. These make them more likely:
- constipation and straining on the toilet
- sitting on the toilet for a long time
- long-lasting diarrhoea
- a low-fibre diet
- pregnancy, when the weight of the baby presses on the area
- heavy lifting and strenuous exercise
- being overweight
- getting older, as the tissues that support the blood vessels weaken and stretch
Piles are very common. About 1 in 20 Americans have them, and about half of adults over 50. They are most common between the ages of 45 and 65, and in one study of people having routine bowel screening, 39% had piles.
Piles or something else?
Fewer than half of people who think they have piles turn out to have piles causing their symptoms. Other causes of a sore, itchy or bleeding bottom look and feel similar:
Swipe sideways to compare →
| Condition | Typical symptoms | Online care? |
|---|---|---|
| Piles | Painless bright red bleeding, itching, a soft lump | Yes |
| Anal fissure | Severe, sharp pain during a poo, burning pain for hours afterwards, bright red blood | Yes |
| Anal itching | Itching of the skin around the opening, without a lump or bleeding | Yes |
| Anal fistula | Blood and yellow slime when pooing, an irritated bottom, or constant pain | Needs an examination in person |
| Warts or an infection caught through sex | Bleeding with or without lumps, itching or pain | Needs tests, often in person |
| Bowel cancer | Blood in the poo, a lasting change in bowel habit, weight loss, tiredness | Needs prompt tests in person |
Do not assume bleeding is from piles, especially if your bowel habits change or your poo changes colour or consistency: bowel and anal cancer can also cause bleeding. A US review for family doctors advises a full bowel examination for anyone over 40 with bleeding from the bottom, unless they have had a normal one in the past 10 years. The blood in poo page explains the causes and the tests, and itching on its own is covered on the anal itching page.
How do you get rid of piles?
Most piles get better on their own within a few days once your poo is soft and you stop straining. The most effective first step is more fibre: fibre supplements halve bleeding from piles and improve symptoms overall. Creams ease the symptoms while the piles settle, and piles that keep coming back can be treated in hospital.
Which cream is best for piles?
No cream shrinks piles for good. Pharmacy creams, ointments and suppositories ease pain, itching and swelling: some contain a local anaesthetic, some a mild steroid such as hydrocortisone, and some soothing ingredients. Most have not been studied for long-term use, so follow the pack instructions, and see a doctor if 7 days of home treatment have not helped.
Banding and other hospital treatments
If piles do not improve with home treatment, or keep coming back, a specialist can treat them:
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| Treatment | How it works | What to expect |
|---|---|---|
| Rubber band ligation (banding) | A band around the base of an internal pile cuts off its blood supply | The pile shrinks and falls off over 1 to 2 weeks; you are awake |
| Sclerotherapy | A liquid is injected to shrink the pile | You are awake, and the area may be numbed |
| Infrared coagulation or electrotherapy | Infrared light or a gentle electric current shrinks the pile | You are awake; the pile may come back more often than after banding |
| Haemorrhoidal artery ligation | Stitches cut off the blood supply to the piles | You are usually asleep |
| Stapled haemorrhoidopexy | The piles are stapled back inside the bottom | You are usually asleep |
| Haemorrhoidectomy | The piles are cut out | For large piles, or when other treatments have not worked; you are usually asleep |
In the long term, banding fails about four times less often than infrared treatment. No treatment always stops piles coming back, which is why the habits below still matter afterwards.
A very painful, hard lump: a clot in a pile
A thrombosed pile is very painful but not dangerous, and it settles over time, like a bruise. Removing the clot within the first 2 to 3 days brings faster relief and makes it less likely to come back, so see a doctor promptly if the pain is severe.
Which piles treatment might the doctor recommend?
Treatment depends on the type and grade of the piles, and on what else your symptoms could mean. This is the framework the doctors use:
Swipe sideways to compare →
| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Small piles with mild itching or discomfort | Fibre, fluids, not straining, a soothing cream | Yes | Not usually needed |
| Painful, swollen piles | Paracetamol, an ice pack, warm baths, a cream with a local anaesthetic or a steroid | Yes | If the pain is severe or not improving |
| Piles with constipation | Fibre, fluids and a laxative to soften the poo | Yes | Not usually needed |
| A sudden, very painful, hard lump | Pain relief and cold packs | Yes, to assess | Within 2 to 3 days, for removal of the clot if the pain is severe |
| Piles that keep coming back, or stay outside | Banding, injections or surgery | Partly | For the procedure |
| Bleeding with a change in bowel habit or weight loss, or over 40 without a recent check | A bowel examination | Partly | For the tests |
| Non-stop or heavy bleeding, large clots, or feeling faint | Emergency care | No | Call 112 now |
Itching, pain or bleeding from piles? A doctor can tell you in one consultation what will help.
See available times →Treatment options for piles
What you can do yourself
- Drink plenty of fluids and eat more fibre, aiming for 30 g a day, to keep your poo soft. Add fibre gradually.
- Go when you feel the urge, do not strain, and do not sit on the toilet longer than you need. Resting your feet on a low stool can help.
- Wipe with damp toilet paper, keep the area clean and dry, and pat it dry rather than rubbing.
- Ease pain and itching with an ice pack wrapped in a towel, or a warm bath for a quarter of an hour or so.
- Gently push a pile back inside if you can.
- Take paracetamol for pain. Avoid painkillers containing codeine, which cause constipation, and ibuprofen if your piles are bleeding.
- Cut down on alcohol and caffeine, and stay active.
Prescription treatment
A prescription is never issued without a consultation. If pharmacy treatments have not helped, the doctor may prescribe a stronger cream or suppository, such as one combining a steroid with a local anaesthetic, for a short time, and a laxative or stool softener for constipation. Painkillers containing codeine make constipation worse, and are never prescribed online. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Using creams for weeks without a review, because most have not been tested for long-term use. Codeine painkillers, which cause constipation. Straining, or reading on the toilet. Assuming bleeding is from piles without a check, especially over 40 or with a change in bowel habit.
Special situations
Pregnancy
Piles are more common in pregnancy, especially with constipation. Drink 2 extra glasses of water a day, and ask your doctor or midwife about a stool softener. The piles in pregnancy page covers what is safe.
Over 40, or bowel cancer in the family
New bleeding from the bottom needs a check even if you have had piles before: bleeding is sometimes a sign of bowel cancer, which is easier to treat when found early.
Piles while travelling in Europe
Changes to your diet and routine, not moving enough and not drinking enough can all bring on constipation, which makes piles worse. Drink plenty, especially in hot weather, keep up your fibre, and pack a soothing cream from home.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When piles are treated online, and when you need in-person care
Treated online: itching, pain and swelling from piles, constipation, small amounts of bright red bleeding that fit piles, a clot in a pile that is settling, and advice on preventing piles.
In-person care: bleeding that needs a bowel examination, a lump that needs examining, a very painful clot that may need removing, banding, injections and surgery, and any emergency sign.
When to get in-person care
Call 112 or go to an emergency department now for:
- bleeding from the bottom that will not stop
- a lot of blood, such as the toilet water turning red, or large blood clots
- dizziness, light-headedness or fainting with bleeding
- black, tar-like poo, or vomiting blood
- severe pain
Get medical advice the same day for:
- a very high temperature, or feeling hot, shivery and generally unwell, with piles
- pus leaking from your piles
- dark red poo, or bloody diarrhoea
- a sudden, very painful, hard lump at your bottom
- a pile that has come out, cannot be pushed back and is very painful
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about your symptoms: describe the bleeding, any lump and the pain, say how your bowels have been, and list the creams you have tried.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s piles? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Anal fissure can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about piles
What are piles?
Piles, or haemorrhoids, are swollen blood vessels inside and around the bottom. Everyone has cushions of blood vessels there; they cause bleeding, itching, pain or a lump only when they swell.
What do piles look like?
Internal piles usually cannot be seen, but they can come out as a soft, pink bulge. External piles are lumps around the bottom, from the size of a pea to the size of a grape, pink or purple. A pile with a clot is a hard, dark blue or purple lump.
How do you get rid of piles at home?
Most get better on their own within a few days. Keep your poo soft with fibre and fluids, do not strain, ease pain with an ice pack or a warm bath, and use a pharmacy cream. Piles that keep coming back can be treated with banding or surgery.
What causes piles?
Piles are caused by pressure in the lower bowel, mainly from constipation and straining. Long sittings on the toilet, long-lasting diarrhoea, a low-fibre diet, pregnancy, heavy lifting, being overweight and getting older all make them more likely.
Do piles go away on their own?
Often, yes: piles settle within a few days. See a doctor if 7 days of home treatment have not helped, if they keep coming back, or if you have bleeding you have not had checked.
What is the most effective way to treat piles?
Softening the poo with fibre and fluids comes first: fibre supplements halve bleeding from piles. For piles that keep coming back, banding is the most common procedure, and surgery is used for large piles or when other treatments fail.
How can I prevent piles coming back?
Avoid constipation and straining: eat 25 to 30 g of fibre a day, drink enough water, exercise regularly, go when you feel the urge rather than holding on, keep toilet visits short and leave the phone outside, use a footstool to raise your knees, and treat diarrhoea promptly; in pregnancy, lie on your side and keep the bowels soft. Piles return in many people, and keeping the poo soft is the single habit that prevents most of it.
What is the best cream for piles?
No cream shrinks piles for good. Creams with a local anaesthetic ease pain, creams with a mild steroid such as hydrocortisone ease swelling and itching, and soothing creams protect the skin. Use them as the pack says, and see a doctor if there is no improvement after 7 days.
Can piles cause diarrhoea?
No, diarrhoea is not a symptom of piles, but long-lasting diarrhoea can cause them, because repeated urgent trips to the toilet, straining and wiping inflame the blood vessels around the bottom; loose stools also make piles itch and leak mucus more. Diarrhoea with blood, or blood mixed into the poo rather than on the paper, needs urgent medical advice rather than a piles cream.
How do you stop mucus from piles?
Keep the area clean and dry, wipe gently with damp toilet paper, and keep your poo soft. If the mucus continues, see a doctor, because piles that keep coming out may need treatment, and other conditions can cause mucus too.
Is bleeding from piles serious?
Small amounts of bright red blood after a poo are common with piles and not usually serious. Heavy or non-stop bleeding, black or dark red poo, or bleeding with a change in bowel habit or weight loss needs a doctor, and heavy bleeding needs 112.
Are piles and haemorrhoids the same thing?
Yes. Haemorrhoids is the medical name, spelled hemorrhoids in American English, and piles is the everyday name in the UK and Ireland; both describe the same swollen blood vessels in and around the anus, internal when they sit inside the anal canal and external when they form under the skin at the opening. Doctors grade internal piles from 1 to 4 by how far they come out.
Can an online doctor treat piles?
Yes, usually. A doctor can assess piles from your symptoms by video, advise on self-care, and prescribe stronger creams or laxatives. Bleeding that needs a bowel examination, and banding or surgery, are in person.
- Piles (haemorrhoids), NHS, National Health Service (UK), reviewed 1 April 2026.
- Piles (haemorrhoids), HSE, Health Service Executive (Ireland), reviewed 2 October 2024.
- Hemorrhoids: diagnosis and treatment options, Mott T, Latimer K, Edwards C. American Family Physician, 2018.
- Definition and facts for hemorrhoids, NIDDK, US National Institute of Diabetes and Digestive and Kidney Diseases, reviewed October 2016.
- Hemorrhoids: symptoms and causes, Mayo Clinic (US), updated 23 August 2025.
- Hemorrhoids, MedlinePlus, US National Library of Medicine, reviewed July 2025.
- What causes hemorrhoids, and when should you see a doctor?, Nebraska Medicine, University of Nebraska Medical Center (US), published 22 August 2022.
- Bleeding from the bottom (rectal bleeding), NHS, National Health Service (UK), reviewed 12 April 2023.
- Bowel cancer: symptoms, NHS, National Health Service (UK), reviewed 4 September 2026.
- Anal fissure, NHS, National Health Service (UK), reviewed 26 June 2025.
- Constipation, NHS, National Health Service (UK), reviewed 26 October 2023.
- How to get more fibre into your diet, NHS, National Health Service (UK), reviewed 2 March 2026.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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Read article →Speak to a doctor about piles over video, usually within 15 minutes
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