1. Location: An obvious one…

• Internal Piles: As the name suggests, internal piles develop inside the rectum. These piles are typically not visible or felt (however can prolapse) because they are located above the anal canal. They are covered by a type of tissue that makes them less sensitive to pain.
• External Piles: These piles form under the skin around the anus, meaning they are visible and can often be felt. They are more accessible than internal piles, making them easier to diagnose and treat.

2. Symptoms: Same but not the same…

• Internal Piles:
  • Bleeding: One of the most common symptoms of internal piles is painless rectal bleeding. You may notice blood on the toilet paper or in the toilet bowl after a bowel movement.
  • Prolapse: In some cases, internal piles can prolapse, meaning they extend outside the anus during bowel movements. When prolapsed, they may cause discomfort and require manual adjustment to be pushed back inside. This is why some patients will assume their piles are external because of this prolapse-however it’s where the blood supply originates that determines the kind of haemorrhoid they have.
  • Discomfort: Internal piles are usually not painful unless they become prolapsed or thrombosed. Most patients will describe a dull ache.
• External Piles:
  • Pain and Itching: External piles are often more painful than internal ones because they are located near sensitive nerve endings around the anus. This pain can worsen when sitting, wiping, or during bowel movements.
  • Swelling: External piles often cause noticeable swelling around the anus. This swelling may be soft at first but can become hard and tender if a blood clot forms inside (thrombosed haemorrhoid).
  • Itching: The area around external piles can become irritated, causing itching or discomfort.

3. Causes: blurred lines…

Both types of piles share common causes, including:

• Straining during bowel movements (often due to constipation or diarrhoea)
• Sitting for long periods
• Pregnancy (due to increased pressure on the pelvic area)
• Obesity (which increases abdominal pressure)
• Age (as the tissues supporting veins weaken over time)
• Poor diet (low in fibre)
• Weight bearing exercise
• Manual occupations involving lifting (builders, warehouse workers, gardeners)

However, because internal piles occur inside the rectum and external piles form around the anus, they can have slightly different risk factors and triggers. For example, straining due to chronic constipation or diarrhoea is more likely to cause internal piles, while prolonged sitting or standing can increase the risk of external piles.

4. Treatment Options: Next steps….

• Internal Piles:
  • Lifestyle Changes: Increasing fibre intake and drinking plenty of water can help soften stools and reduce the need to strain during bowel movements.
  • Medications: Over-the-counter creams or suppositories can reduce inflammation and discomfort.
  • Procedures and treatments: In more severe cases, a doctor may recommend procedures such as rubber band ligation (which cuts off the blood supply to the haemorrhoid), sclerotherapy (injecting a solution to shrink the haemorrhoid), electrotherapy (sealing off the blood supply by creating an excess of alkali which accumulates to see off the feeding varicose blood vessel).
  • Surgical Intervention: In the most extreme cases surgical removal (haemorrhoidectomy) may be required.
• External Piles:
  • At-Home Remedies: For external piles, sitz baths (soaking the area in warm water) can help soothe the discomfort. Over-the-counter topical creams or wipes with hydrocortisone can reduce swelling and irritation.
  • Cold Compresses: Applying cold packs to the affected area can reduce swelling and provide temporary pain relief.
  • Surgical Treatment: In cases where external piles become thrombosed (when a blood clot forms), a doctor may need to remove the clot through a minor surgical procedure. In some cases, surgical removal of external piles may be necessary.

5. When to Seek Medical Help….

While piles can often be treated at home with simple lifestyle changes and over-the-counter remedies, it’s important to seek medical advice if you experience:

• Persistent bleeding
• Severe pain that doesn’t improve with home treatment
• Prolapsed piles that do not return to their normal position
• Any changes in bowel habits or other symptoms that concern you

6. Conclusion

Understanding the difference between internal and external piles is essential for managing and treating this common condition. While both types share some similarities, their location, symptoms, and treatment options differ. If you’re experiencing symptoms of piles, it’s important to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan tailored to your needs.

If you feel that you have internal piles that need treatment, for further information please reach out to exroid.com, where we have a dedicated team ready to help and guide you through our treatment option – the least invasive option within minimum downtime and proven effectiveness.

Please use our form below to arrange a consultation with our Patient Services team.