Extremely common and usually easy to settle. The risk is not the piles — it is assuming that is all it is.
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Piles — haemorrhoids — are swollen blood vessels in and around the anus. They are extremely common, they are not dangerous, and most settle with simple measures.
But this page has to start somewhere else, because one point matters more than everything else on it.
Never assume rectal bleeding is piles. Bowel cancer causes bleeding that looks exactly the same, and "I thought it was just my piles" is one of the commonest reasons a diagnosis is delayed by months. Piles are extremely common, which means plenty of people have piles and something else. Bleeding needs assessing on its own merits — particularly over 50, or alongside a change in bowel habit, weight loss or anaemia.
Two other things worth knowing:
And one modern contributor nobody mentions: taking your phone to the toilet. Prolonged sitting on the toilet is a genuine cause, and it is a newer one than it used to be.
They are graded by how far they come down — from bleeding only, through prolapsing and reducing themselves, to staying permanently outside. The grade determines the treatment options rather than how bad it feels.
Sudden, severe pain with a firm purple lump at the anus. A clot has formed inside it. It is intensely painful for a few days, then eases over one to two weeks.
Seen within the first 48 to 72 hours, it can be treated with a small procedure that gives immediate relief. After that, it is managed with pain relief and time — which is why getting seen quickly is worth it.
Raised pressure in the veins around the anus, and weakening of the tissue that holds the cushions in place. Repeated straining does both.
Ten or fifteen minutes sitting on the toilet is long enough to cause the problem you are trying to solve. Go when you need to, take the time you need, and leave. Do not take reading material — electronic or otherwise.
Very common, particularly in the third trimester and immediately after delivery. Most settle in the weeks after birth. Treatment is available and safe in pregnancy — there is no need to endure it.
A clear photograph of an external lump is often enough to distinguish a thrombosed pile, a skin tag and a fissure, and can save a journey. Internal haemorrhoids cannot be assessed this way.
The threshold for investigating is deliberately low, and it is right that it is.
This is the actual treatment. Soft stool passed without straining lets piles settle on their own:
If the picture is a fissure rather than piles, the treatment is stool softening plus a GTN or diltiazem ointment to relax the internal sphincter and allow healing. Headache is a common effect of GTN ointment and is worth expecting. This is a genuinely different treatment, which is why the distinction matters.
Referred, not done here: banding — quick, effective, done in clinic — sclerotherapy, and surgery for larger or persistent piles. A thrombosed external pile can be treated by a small incision if seen within 72 hours.
Very common. Softeners and topical treatments safe in pregnancy, with the reassurance that most improve substantially after delivery.
Rectal bleeding needs assessing against the suspected cancer criteria, and these are the situations where that applies:
This applies even if you know you have piles. Having haemorrhoids and having something else are not mutually exclusive, and the overlap is exactly where late diagnoses come from.
Rubber band ligation is done in outpatients, takes minutes and works well for grade 1 to 3 internal piles. Surgery is reserved for large or persistent haemorrhoids, and recovery is genuinely uncomfortable — worth knowing before choosing it.
For straightforward piles, a pharmacist and a fibre supplement will resolve most cases without anyone charging you.
This page follows NICE Clinical Knowledge Summaries on haemorrhoids, NICE guideline NG12 on suspected cancer referral, and NICE DG56 on faecal immunochemical testing.
Guidance is explicit that the presence of haemorrhoids does not exclude coexisting colorectal pathology, and that attributing rectal bleeding to haemorrhoids without assessment is a recognised cause of delayed cancer diagnosis.
Reviewed against NICE CKS, NICE NG12 and NICE DG56 guidance current at the date shown above.
Yes — this is the most important answer on the page. Having haemorrhoids does not stop you having something else, and both are common in the same age group.
"It's just my piles" is a recognised route to a late bowel cancer diagnosis. The bleeding needs a cause established, not assumed.
Internal ones usually do not. They bleed, itch and feel uncomfortable, but significant pain is not typical.
Severe pain on and after passing a stool is more likely a fissure, and a sudden painful lump is likely a clotted external pile — both treated differently.
Because sitting for ten or fifteen minutes on an open seat lets the cushions engorge, which is exactly how piles develop and persist.
It is the least medical and most effective advice here. Go, do what you came for, and leave.
Fibre, fluid, and not straining. It is unexciting and it works for most people.
Creams relieve symptoms; they do not treat the cause, and steroid-containing ones should not be used beyond about a week.
Get seen within 48 to 72 hours if you can. A clotted external pile can be treated with a small procedure that gives immediate relief in that window.
After that it is managed with pain relief and time, easing over one to two weeks.
Yes, and it is often genuinely useful. A clear photograph can distinguish a thrombosed pile, a skin tag and a fissure.
Internal haemorrhoids cannot be assessed that way — they need a proctoscope.
There are safe options, and there is no need to put up with it. Managing constipation is the main thing.
Check what is suitable rather than buying something off the shelf, and expect most to settle in the weeks after birth.
They can, particularly if the underlying constipation and toilet habits do not change.
Fibre, fluid and short toilet visits are what prevent recurrence — not repeated courses of cream.
A small rubber band is placed at the base of the pile so it shrinks and drops off. It takes a few minutes in outpatients and does not need an anaesthetic.
Most people describe a dull ache rather than pain, and it works well for internal piles that have not settled with self-care.
For large or persistent haemorrhoids, yes — but the recovery is genuinely uncomfortable, often for a couple of weeks.
It is worth knowing that beforehand, and it is why banding and conservative treatment are tried first.
September 8, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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