Piles. Haemorrhoids. The thing nobody wants to talk about but almost everyone will deal with at some point.
As a GP, I can tell you this: if you have a bottom, you’re in the club.
Yet despite how common they are, piles remain one of the most awkward, misunderstood, and quietly suffered conditions I see in clinic.
Patients will happily tell me about chest pain, sex problems, even bowel habits – but mention bleeding from the back passage and suddenly voices drop, eyes avert, and we’re speaking in code.
So, let’s cut through the embarrassment.
Piles are swollen blood vessels in and around the anus. That’s it. No mystery, no shame. You already have these blood vessels, they’re normal. They just become enlarged and irritated.
They can be inside, where they’re often painless but may bleed – or outside, where they’re more likely to hurt, itch or swell. And yes, they can make your life miserable.
If you’re wondering whether what you’re dealing with is piles, the symptoms are usually quite recognisable. Bright red blood on loo paper or in the bowl, itching or irritation down there, a feeling of something hanging or bulging, discomfort when sitting, or that annoying sensation that you haven’t quite finished after a bowel movement.
Despite how common they are, piles remain one of the most awkward, misunderstood, and quietly suffered conditions I see in clinic, writes Dr Raj Arora
So why do they happen? The uncomfortable truth is that modern life is basically designed to give you piles. The biggest culprits are straining, constipation, sitting for too long, low-fibre diets, pregnancy and heavy lifting.
And then there’s the habit many people have of turning the loo into a second living room. If you’re spending ten or 15 minutes scrolling on your phone while waiting, you’re putting unnecessary pressure on the blood vessels in your bottom.
Your bowel isn’t a waiting room. Go when you need to go – and then get up.
Most piles are not dangerous, but they are uncomfortable.
The real problem is when you ignore them or self-diagnose, hoping they will disappear without making any changes.
They tend to persist if the underlying cause isn’t addressed.
What helps is often simple but requires consistency.
Fibre is non-negotiable. If your diet is low in fibre, your bowels will reflect that. Vegetables, fruit, wholegrains, or even fibre supplements can make a significant difference.
‘Straining should not be seen as normal. If you are pushing hard every time you go, something needs to change.’
Hydration is just as important because fibre without enough fluid can worsen constipation.
Over-the-counter creams can help with itching and inflammation and provide short-term relief. But if you find yourself relying on them for weeks, you are likely missing the bigger issue.
Your toileting habits matter more than you think. Don’t ignore the urge to go, don’t sit there for long periods, and yes, even something as simple as using a small footstool can help improve positioning and reduce strain.
Straining should not be seen as normal. If you are pushing hard every time you go, something needs to change.
There are times when you should seek medical advice.
If bleeding is persistent; if you are over 40 with new symptoms; if there is a change in bowel habit; unexplained weight loss; or if the pain is severe or getting worse, it is important to get checked.
While piles are common, not everything that bleeds is a pile.
If symptoms don’t improve with the simple lifestyle measures mentioned above, there are effective treatments available to get rid of piles – including injections or procedures that cut off their blood supply and make them shrink. In some cases, surgery might be necessary to remove them – but rest assured, it is usually straightforward and far less daunting than people imagine.
From a GP perspective, the biggest issue is not the condition itself but the embarrassment surrounding it that stops people seeking help.
I have seen patients suffer for years with bleeding, pain and discomfort simply because they felt too awkward to bring it up.
Piles are common, treatable and usually harmless, but they are also a signal that something in your lifestyle, whether that is diet, hydration or bowel habits, needs attention. Ignoring it won’t help. Addressing it will.
And if you are worried, please speak up. Your GP has heard it all before.
