Piles, also known as hemorrhoids, are a common health condition affecting millions of people globally. They can be uncomfortable and even painful, but with the right knowledge and care, they are manageable. One of the most important aspects of treating piles is knowing the difference between internal and external piles.
In this blog, we will explain what internal and external piles are, how they differ, their causes, symptoms, treatments, and preventive tips—all in easy-to-understand language.
What Are Piles (Hemorrhoids)?
Piles are swollen veins located in the lower part of the anus and rectum. These veins can become inflamed due to pressure or strain, leading to discomfort or bleeding.
There are two main types of piles:
- Internal piles (inside the rectum)
- External piles (under the skin around the anus)
Both types can vary in severity and symptoms, which makes it important to understand their differences.
Internal Piles – A Closer Look
Internal piles are located inside the rectum, which means they are usually not visible. Many people don’t even realize they have them unless they bleed or prolapse (come out of the anus).
Characteristics of Internal Piles:
- Located inside the rectum
- Usually painless
- May bleed during bowel movements
- Sometimes prolapse outside the anus
- Less irritating than external piles
Internal piles are often detected when blood is noticed in the stool or toilet paper. In many cases, they don’t cause pain because this area has fewer pain-sensitive nerves.
External Piles – A Closer Look
External piles, on the other hand, are found outside the anal opening, under the skin around the anus. They are often visible and can be felt as lumps.
Characteristics of External Piles:
- Found under the skin around the anus
- Can cause pain, swelling, and itching
- May form hard lumps if a blood clot develops
- Easily irritated by wiping or sitting
- More painful than internal piles
These are more likely to cause discomfort, especially when sitting, walking, or during bowel movements.
Key Differences Between Internal and External Piles
Understanding the difference between internal and external piles is crucial for choosing the right treatment. Here’s a breakdown of the major differences:
| Feature | Internal Piles | External Piles |
|---|---|---|
| Location | Inside the rectum | Outside the anal opening |
| Visibility | Not visible externally | Visible and can be felt |
| Pain | Usually painless | Often painful or itchy |
| Bleeding | Common during stool | Less common but possible |
| Irritation | Less irritation | Easily irritated |
| Treatment focus | Diet and lifestyle changes | Pain relief and clot removal |
Causes of Piles
Both internal and external piles have similar causes. They occur when there’s increased pressure on the veins in the lower rectum. Some common causes include:
- Chronic constipation
- Straining during bowel movements
- Prolonged sitting on the toilet
- Pregnancy
- Obesity
- Low-fiber diet
- Lifting heavy objects regularly
Reducing these risk factors can help prevent piles from developing or getting worse.
Symptoms of Internal Piles
Internal piles often go unnoticed, but as they worsen, they can show the following symptoms:
- Painless bleeding during bowel movements
- Blood on the toilet paper or in the toilet
- Feeling of incomplete bowel movement
- Prolapsed piles that may go back in or need to be pushed manually
- Mucus discharge or irritation in the anal region
Since they are located inside, internal piles are usually not felt unless they prolapse or become severe.
Symptoms of External Piles
External piles are usually more painful and irritating. You may experience:
- Pain and discomfort, especially when sitting
- Swelling or lumps around the anus
- Itching or irritation
- Bleeding (less common than with internal piles)
- Thrombosis (a blood clot in the hemorrhoid, causing a hard, painful lump)
Because of their location and the presence of more nerves, external piles tend to hurt more than internal ones.
How to Diagnose Piles?
If you suspect you have piles, it’s important to visit a doctor for a proper diagnosis. A medical professional may:
- Ask about your symptoms and bowel habits
- Perform a physical examination
- Conduct a rectal exam using a gloved finger
- Use a proctoscope to see inside the rectum (for internal piles)
Don’t be embarrassed—piles are common, and doctors deal with them regularly.
Treatment Options for Internal Piles
Mild internal piles often go away with home care, but larger ones may need medical treatment.
Home Remedies:
- Eat high-fiber foods like fruits, veggies, and whole grains
- Drink plenty of water
- Avoid straining on the toilet
- Take warm sitz baths
- Use over-the-counter creams or ointments
Medical Treatments:
- Rubber band ligation (cutting off blood supply)
- Sclerotherapy (injection to shrink the piles)
- Infrared coagulation (burning the piles)
- Surgery (for large, prolapsed piles)
Treatment Options for External Piles
External piles can be more bothersome, but they’re also treatable.
Home Remedies:
- Apply cold compresses
- Use anti-itch or anti-inflammatory creams
- Keep the area clean and dry
- Take pain relievers like ibuprofen or acetaminophen
- Avoid sitting for long periods
Medical Treatments:
- Thrombectomy (removal of blood clots in external piles)
- Excision (removing piles with surgery)
- Laser or infrared treatment (less invasive)
Consult a doctor if home remedies don’t work or symptoms worsen.
Can Internal Piles Become External?
Yes, in some cases, internal piles can prolapse, meaning they fall out of the anal canal and appear outside the anus. When this happens:
- You might feel a soft lump during bowel movements
- It may go back on its own or need to be pushed manually
- It can cause pain, itching, or irritation
Prolapsed internal piles are treated based on how often and severely they protrude.
When to See a Doctor
While many piles can be treated at home, you should see a doctor if:
- Bleeding is heavy or persistent
- You experience extreme pain or swelling
- There is a hard lump near the anus
- Home treatments aren’t working
- You have a family history of colon or rectal cancer
Getting timely help ensures the problem doesn’t worsen or lead to complications.
Preventing Piles – Tips That Work
Preventing piles is often easier than treating them. Here’s how to avoid both internal and external piles:
Eat a Fiber-Rich Diet:
- Helps soften stool and prevent constipation
- Include fruits, veggies, whole grains, and legumes
Drink Plenty of Water:
- Aim for 8-10 glasses a day
- Keeps your digestive system running smoothly
Exercise Regularly:
- Prevents pressure build-up in the rectal veins
- Helps with bowel regularity
Don’t Delay Bowel Movements:
- Holding in stool increases pressure
- Go as soon as you feel the urge
Avoid Straining:
- Don’t push hard during bowel movements
- Try squatting or elevating your feet for easier passage
Myths About Piles – Debunked
Let’s clear up some common myths about piles:
- Myth: Only old people get piles
Fact: Piles can occur at any age, even in young adults and teenagers. - Myth: Spicy food causes piles
Fact: Spicy food might irritate existing piles, but doesn’t cause them directly. - Myth: Piles always need surgery
Fact: Most piles are managed with lifestyle changes and non-surgical treatments. - Myth: Bleeding always means piles
Fact: Rectal bleeding can be a sign of other conditions. Always consult a doctor.
Long-Term Management of Piles
Once you’ve treated piles, either through home care or medical help, the next step is long-term management. This is essential to prevent recurrence and maintain a healthy digestive system.
Tips for Managing Internal and External Piles Long-Term:
- Stick to a high-fiber diet: Continue eating plenty of fruits, vegetables, and whole grains.
- Use stool softeners if necessary: Especially during constipation flare-ups.
- Avoid prolonged sitting: Take short walks or stand up regularly if your job requires long sitting hours.
- Don’t ignore the urge to go: Delaying bowel movements causes hard stools, which lead to straining.
- Do pelvic floor exercises: These strengthen the anal muscles and improve bowel control.
- Avoid lifting heavy objects: This puts pressure on the rectal veins and may worsen piles.
Consistency in lifestyle habits can prevent piles from coming back, even if you’re prone to them due to genetics or past conditions.
Complications of Untreated Piles
Ignoring piles can lead to serious health problems over time. Even though piles are not life-threatening, they can severely affect your daily comfort and mental well-being.
Possible Complications Include:
- Chronic pain and itching around the anus
- Severe bleeding, leading to anemia
- Prolapsed internal piles that become irreducible
- Infection due to poor hygiene or ruptured piles
- Strangulated piles, where the blood supply gets cut off
- Fistula formation, a rare but serious condition
That’s why it’s important to take any signs seriously, especially if the pain or bleeding persists despite self-care.
Foods to Eat and Avoid for Piles
Your diet plays a major role in both the treatment and prevention of piles. What you eat directly affects your bowel movements, which in turn impacts pile formation.
Best Foods for Piles:
- Leafy greens like spinach and kale
- Fruits with skin (apples, pears, plums)
- Whole grains such as oats, quinoa, and brown rice
- Legumes like lentils, chickpeas, and beans
- Water-rich foods like cucumber, melon, and celery
- Flaxseeds or chia seeds for fiber and omega-3s
Foods to Avoid:
- Refined carbohydrates (white bread, pasta)
- Spicy foods can worsen irritation.
- Processed meats
- Fried and oily foods
- Low-fiber junk food
- Caffeinated or carbonated beverages in excess
Hydration is just as important. Aim to drink at least 2-3 liters of water daily to help soften stools and keep your digestive system moving.
Also Read:
- Foods to Avoid with Piles: A Complete Guide to Healthy Eating
- Top 7 Hemorrhoid Suppositories for Bleeding Piles: A Complete Guide
- Best Over the Counter Piles Treatment Cream: Complete Guide for Fast Relief
Lifestyle Changes to Prevent Piles
Along with diet, your daily habits influence your chances of getting internal or external piles. Adopting healthy routines is essential for digestive and anal health.
Healthy Lifestyle Habits:
- Stay active: 30 minutes of walking or moderate exercise daily helps digestion.
- Use the bathroom at regular times: Establish a schedule for bowel movements.
- Keep good hygiene: Use mild soap and warm water to clean the anal area gently.
- Don’t use dry toilet paper: Try using moist wipes or water to avoid irritation.
- Avoid sitting too long on the toilet: Get up if nothing happens after a few minutes.
By making these changes, you’re not just managing piles—you’re also promoting better overall health.
Frequently Asked Questions (FAQs)
Let’s go through some common questions people have about the difference between internal and external piles.
Which type of piles is more painful?
External piles are usually more painful because the area around the anus is more sensitive. Internal piles are often painless unless they prolapse or become severe.
Can both types of piles occur together?
Yes, some people can have mixed piles, which means they have both internal and external piles at the same time.
Do internal piles always bleed?
Not always. But bleeding during bowel movements is one of the most common signs of internal piles. If it happens frequently, you should consult a doctor.
Can piles go away on their own?
Mild piles, especially internal ones, can go away with simple diet and lifestyle changes. However, severe or chronic piles may require medical treatment.
Is surgery the only option for external piles?
No. Many external piles can be managed with topical treatments, sitz baths, and pain relief. Surgery is recommended only in persistent or complicated cases.
Can sitting on hard surfaces cause piles?
Not directly, but sitting for long periods increases pressure in the rectal veins, which can worsen or trigger piles.
Are piles dangerous or cancerous?
No, piles themselves are not cancerous. However, because some symptoms like bleeding can mimic colorectal cancer, it’s important to get properly diagnosed.
Emotional Impact of Piles
Many people suffering from piles feel embarrassed or anxious to talk about their condition. This often delays proper treatment.
But remember:
- Piles are very common and nothing to be ashamed of.
- Seeking help early leads to faster recovery.
- Talk openly with your doctor or health professional.
A problem hidden is a problem worsened. By acknowledging the condition, you open the door to healing and comfort.
Natural and Ayurvedic Remedies
Some people prefer natural or herbal treatments for managing piles. These remedies can support relief, especially in the early stages.
Popular Natural Remedies:
- Witch hazel: Soothes itching and pain
- Aloe vera: Reduces swelling and irritation
- Triphala powder: A traditional Ayurvedic remedy for digestion
- Coconut oil: Natural anti-inflammatory and moisturizer
- Buttermilk with carom seeds (ajwain): Helps digestion and soothes the gut
⚠️ Always consult a doctor before using herbs, especially if you’re on medication or have other health conditions.
Final Thoughts: Understanding the Real Difference Between Internal and External Piles
Let’s recap the main difference between internal and external piles:
| Internal Piles | External Piles |
|---|---|
| Located inside the rectum | Located outside the anus |
| Usually painless | Often painful and itchy |
| May bleed during stool | May form painful lumps |
| Not visible | Visible as lumps |
| Diagnosed with a rectal exam | Diagnosed via physical inspection |
Knowing this difference is key to managing your symptoms effectively. Whether you’re dealing with minor irritation or a more serious case, the first step is noticing your symptoms and making healthy changes.
Understanding the difference between internal and external piles helps you manage the condition better and seek the right treatment. While both types can be uncomfortable, they are highly treatable and often preventable with simple lifestyle changes.
Don’t ignore symptoms. If you experience discomfort, bleeding, or pain, talk to a healthcare provider. Early treatment leads to quicker relief and better outcomes.
Summary: Key Points to Remember
- Internal piles occur inside the rectum and are often painless.
- External piles develop under the skin around the anus and can be painful or itchy.
- Both types share common causes like constipation and straining.
- Treatments range from home remedies to medical procedures.
- Prevention is possible through diet, exercise, and healthy bathroom habits.
