How to treat or cure piles

Most piles improve with simple measures, and many do not need surgery.

Step 1: confirm the diagnosis

A doctor examines the anus, and may do a proctoscopy or, in selected cases, a colonoscopy, especially if you are over 40 or have bleeding. Bleeding should not be assumed to be piles.

Step 2: lifestyle treatment

• More fibre and water
• No straining and short toilet time
• Warm sitz baths
• Weight control and daily activity

Step 3: medicines

Fibre supplements, stool softeners and soothing creams relieve symptoms. Use steroid creams only for short courses.

Step 4: office procedures

For grade 1 to 3 internal piles that persist:

• Rubber band ligation: the most common procedure
• Sclerotherapy: injection to shrink the piles
• Infrared coagulation

Step 5: surgery

Considered for grade 3 to 4, large or clotted piles, or when other treatment has failed. Options include haemorrhoidectomy and stapled procedures. Recovery takes a few weeks, with some pain.

Thrombosed piles

If seen within about 72 hours, a small procedure can relieve pain. After that, warm baths and painkillers often help it settle.

Preventing return

Piles can return unless the cause is treated. Keep up fibre, fluids and healthy toilet habits.