Stages of piles

Doctors grade internal piles into four degrees, based on how far they come down.

Grade 1

Piles stay inside the rectum and may bleed during a bowel movement but do not come out. Treatment is usually diet, fluids and avoiding straining.

Grade 2

Piles come out during passing stool but go back on their own. Bleeding, itching and mucus can occur. Lifestyle change and sometimes medicines or office procedures help.

Grade 3

Piles come out and must be pushed back with a finger. Office procedures such as rubber band ligation or sclerotherapy are often used.

Grade 4

Piles stay outside and cannot be pushed back. They may be painful, especially if clotted or strangulated. Surgery is often advised.

External piles

These are not graded the same way. They are described by size and by whether they are clotted (thrombosed).

How piles progress

Without changing the cause, such as constipation and straining, piles can slowly progress to a higher grade over months or years. Early care often prevents this.

Ayurvedic view (interpretive)

Traditional texts classify Arsha by dosha and by whether it is bleeding or dry, and by how curable it is. This is a conceptual comparison only.

When to get help

See a doctor early for bleeding, a lump that does not go back, or severe pain.

Small steps taken early work better than waiting for symptoms to become severe.

Staging is done by a doctor during examination. Do not try to judge the grade yourself, and do not assume that bleeding means grade 1 piles, because other conditions can look similar.