What are haemorrhoids?

Piles, or haemorrhoids, are swollen veins in the rectum that supply the anal canal (anus) with blood. Piles are separated into two categories, namely internal and external. Their position is normally four, seven and eleven o’clock on a watch. Between these piles new ones, called secondary piles, may develop after the original ones have been removed. There are various grades of piles.

Grade Types

Grade 1: Enlarged piles which are in the normal position.

Grade 2: Enlarged piles that prolapse (slip out) with every defecation but move back spontaneously.

Grade 3: Enlarged piles that prolapse and do not move back spontaneously, but can be pushed back by hand.

Grade 4: Enlarged piles that are prolapsed and irreducible (cannot be shrunk).

Thrombolised piles

Coagulated piles in grades 1, 2, 3 or 4 that form a thrombus (blood clot). Very painful and swollen and can become inflamed if not treated in time.


  • Clear bleeding from the anus which can be seen when wiping
  • A feeling that something is hanging out
  • Normally piles are not painful but sometimes pain may be experienced. Thrombolised piles are inflamed and painful
  • In some cases an anal fissure may appear
  • Piles cannot always be seen unless they prolapse

Patients should seek medical advice if they experience any pain in the region of their anus.

Causes of haemorrhoids

  • A history of constipation
  • A history of long-term pressure with every defecation
  • Pregnancy – but in this case it usually clears up by itself
  • A low fibre diet
  • A low intake of fluids


  • Can be treated conservatively, i.e. with medication, depending on the grade of the piles
  • Change of diet: high fibre, plenty of fluids
  • Good toilet habits: no pressure, regular visits to the toilet and no holding back until later
  • Grades 1 and 2 can be successfully treated conservatively
  • Grades 3 and 4 need to be surgically removed under general anaesthesia in the hospital

Surgery and post-operative care

  • The surgeon will make arrangements for the operation under general anaesthesia
  • The patient may not eat or drink anything for six hours before the operation
  • After the operation there may still be minimal bleeding for seven to eight days or longer
  • Medication to keep stools soft will be prescribed
  • Plenty of fluids must be taken
  • After the operation, the patient takes sitz baths in hospital