Piles in men: symptoms, causes and what helps

The Association of Coloproctology of Great Britain and Ireland (ACPGBI) thinks at least one person in three in Britain will have piles at some stage in their life. NHS inform notes that some people with piles are reluctant to see their GP, though GPs are used to diagnosing and treating them.

This guide covers the symptoms, the causes, what helps at home and the signs that need help quickly.

What are piles (haemorrhoids)?

Piles, also called haemorrhoids (hemorrhoids in American spelling), are swollen blood vessels in and around your bottom (anus). The back passage normally has blood-filled cushions that, in ACPGBI's words, act as a seal "just like the washer in a tap". When those cushions get bigger and can stick out or bleed, they are known as piles.

NICE's Clinical Knowledge Summaries for GPs (NICE CKS) split piles into two kinds, depending on where they start in relation to the dentate line, which sits 2cm in from the edge of the anus:

• Internal piles start above that line, where the lining has no pain fibres, so they are not sensitive to touch or pain unless they become strangulated.
• External piles start below it, under skin that is rich in pain fibres, so they can be itchy and painful.

You can have both at once. Internal piles are also graded from 1 to 4 by how far they come down; our guide to what piles look and feel like explains the grades in plain words.

How common are piles?

Piles are very common but hard to count, because NICE CKS says only a small percentage of people with piles see a doctor. It puts the share of people with piles in any one year at around 10%, and says that in both men and women, piles are most common between the ages of 45 and 65.

UK community studies found piles in 13% to 36% of people, but NICE CKS warns that this is probably too high, because the studies relied on people reporting their own symptoms and many bottom problems are wrongly blamed on piles.

What are the symptoms of piles?

Symptoms of piles, according to the NHS, include:

• bright red blood after you poo
• an itchy anus
• feeling like you still need to poo after going to the toilet
• mucus in your underwear or on toilet paper after wiping your bottom
• lumps around your anus
• pain around your anus

Some people have none of these: NHS inform says that in many cases piles cause no symptoms, and some people don't realise they have them.

NICE CKS says bleeding is the most common symptom. It is typically bright red and painless, comes with a poo, and shows as streaks on the toilet paper, blood in the toilet bowl or blood on the outside of the poo rather than mixed into it. Our guide to bleeding from your bottom covers what the colour and amount of blood can mean.

Do piles hurt?

Often only a little: ACPGBI says piles often cause discomfort but are not very often acutely painful. NICE CKS explains the exceptions: an internal pile that comes down and gets strangulated causes intense pain, and an external pile becomes painful if a blood clot forms in it (a thrombosed pile). If you have severe pain when you poo along with bleeding, ACPGBI says it may be a tear in the back passage instead, an anal fissure.

Are piles itchy?

They can be: an itchy anus is on the NHS list of symptoms. But ACPGBI says itching and soreness in people with piles are often caused by a skin condition around the back passage rather than by the piles themselves. Our guide to an itchy bottom covers the other causes.

What causes piles in men?

The NHS says it's not clear what causes piles, but some things make them more likely. Of the six it lists, five apply to men: constipation, pushing too hard when pooing, heavy lifting, getting older and being overweight. NICE CKS adds a long-term cough, exercising, a family tendency and a low-fibre diet, and says these all raise the pressure in the anal cushions.

Straining and constipation

Constipation and straining come first on both lists. Expert opinion cited by NICE CKS is that passing hard poo increases the shearing force on the anal cushions. The NHS says the most common causes of constipation include not eating enough fibre, not drinking enough fluids, not moving enough, and often ignoring the urge to go to the toilet.

Heavy lifting and the gym

Heavy lifting is on both lists, and NICE CKS lists exercising too, but neither says how much weight is too much or which exercises to avoid. The NHS also suggests a daily walk or run to help you poo more regularly. When your bottom is sore, the NHS advice for anal pain includes not lifting or carrying anything heavy.

Long sessions on the toilet (and your phone)

The NHS says not to spend more time than you need to on the toilet. A 2025 study in the journal PLOS One looked at smartphone use on the toilet. It surveyed 125 adults having a screening colonoscopy at one hospital in Boston, in the US. The 66% who used a smartphone on the toilet spent longer there: 37.3% of them sat for more than five minutes per visit, against 7.1% of those who didn't. After allowing for age, sex, body mass index, exercise, straining and fibre, smartphone use on the toilet was linked to a 46% higher risk of piles.

As a one-off snapshot, the study can't show that phones cause piles. It also relied on people's own reports of their toilet habits, and everyone in it was 45 or older. Among the phone users, men appeared more likely than women to sit for six minutes or more, but the difference wasn't statistically significant.

What about sitting at a desk or driving all day?

Prolonged sitting in general hasn't been definitively linked to piles, the same paper notes; its authors suggest a toilet seat is different because, unlike a chair, it gives the pelvic floor no support. Long spells of sitting can still play a part indirectly: the NHS lists not moving enough and spending long periods sitting or lying down among the common causes of constipation.

Getting older, weight and a cough

Both the NHS and NICE CKS list getting older, and NICE CKS explains that the tissues supporting the anal cushions weaken with age, so piles are more likely to come down. The NHS lists being overweight, and NICE CKS lists a long-term cough and a family tendency, possibly from vein walls that are weaker from birth.

Are piles dangerous?

Piles are rarely dangerous. ACPGBI says they can often be troublesome and need treatment, but they are almost never life-threatening, and NICE CKS says the outlook is usually good. The main concern is making sure it really is piles, because bleeding from the back passage can also be an important warning sign of bowel cancer.

That is why, ACPGBI says, tests are often done mainly to rule cancer out. NICE CKS lists the possible complications, including a blood clot in a pile, piles that come down and can't be pushed back (which can cause severe pain), skin tags, and, rarely, infection or anaemia from continuous or heavy bleeding.

How long do piles last, and do they go away?

Piles often go away on their own. The NHS says they often get better after a few days, and NICE CKS describes symptoms that come and go, lasting from a few days to a few weeks. A clotted (thrombosed) pile can take longer: NICE CKS says its pain usually peaks 48 to 72 hours after it starts and settles by itself within 7 to 14 days.

They can come back. NICE CKS says many flare-ups settle with simple measures and recurrence rates are low, but piles are more likely to return if the things behind them, such as constipation and straining, carry on. About 10% of people with piles need surgery to relieve their symptoms, it says, and the NHS notes that hospital treatment does not always stop piles coming back either.

How do you get rid of piles at home?

To get rid of piles at home, the NHS advice is to keep your poo soft with lots of fluid and plenty of fibre, and to avoid straining or spending longer than you need on the toilet. It also suggests paracetamol, an ice pack or a warm bath for pain and itching, and keeping your bottom clean and dry.

NICE CKS says many flare-ups settle with simple measures like these. The NHS list in full:

Do:

• gently push a pile back inside if you can
• take paracetamol if piles hurt
• use an ice pack wrapped in a towel to ease discomfort
• drink lots of fluid and eat plenty of fibre to keep your poo soft
• take a warm bath to ease itching and pain
• keep your bottom clean and dry, patting (rather than rubbing) it dry
• cut down on alcohol and caffeine (like tea, coffee and cola) to avoid constipation

Don't:

• ignore the urge to poo
• push too hard when pooing
• take painkillers that contain codeine, as they can cause constipation
• take ibuprofen if your piles are bleeding
• spend more time than you need to on the toilet

How much fibre do you need?

Government guidelines, the NHS says, are 30g of fibre a day, while most adults eat only about 20g. Wholegrain cereal or porridge, wholemeal bread, potatoes with their skins on, beans, lentils, vegetables and fruit all add fibre. NICE CKS advises increasing fibre gradually to keep wind and bloating down, and drinking enough fluid alongside it.

Toilet habits that help

The NHS advice on constipation adds a toilet routine: keep to a regular time and place, don't delay when you feel the urge to poo, and try resting your feet on a low stool, with your knees above your hips if possible. For washing and drying gently afterwards, see our guide to how to use a bidet, wipe and wash.

What can a pharmacist give you for piles?

For piles treatment, a pharmacist can suggest creams to ease the pain, itching and swelling, treatments such as laxatives to help constipation and soften poo, and cold packs to ease discomfort, the NHS says. Many pharmacies have a private area if you don't want to be overheard.

NICE CKS says there is little evidence that pile creams help prevent piles or treat them in the long term, although guidelines still recommend them for relieving symptoms. It quotes the British National Formulary (BNF): creams containing local anaesthetics and corticosteroids may relieve symptoms by reducing inflammation around the anus, but they do not affect swelling, the pile coming down, or bleeding.

For constipation, the NHS says most laxatives work within 3 days and should only be used for a short time; a pharmacist can suggest a suitable one.

When should you see a GP, call 111 or go to A&E?

See a GP if your piles are getting worse or not improving after home treatment, if you keep getting piles, or if you notice a change around your anus that is not normal for you. Some signs need help faster. The table below sets out the NHS's signs and who to contact, and the NHS says to see a GP if you're worried.

Piles: the signs and who to contact

	What to do.
Bright red blood after a poo, an itchy anus, lumps, mucus or pain around the anus	Try the NHS self-care steps above; a pharmacist can suggest creams, laxatives and cold packs; a GP can check any bleeding from the bottom
Piles getting worse, or no better after home treatment; piles that keep coming back; a change around your anus that is not normal for you	See a GP
Blood in your poo for 3 weeks; poo softer, thinner or longer than normal for 3 weeks; a lot of pain around the bottom; a pain or lump in your tummy; more tired than usual; weight loss for no reason	See a GP
Piles with a very high temperature, or feeling hot, cold or shivery and generally unwell; piles with painless bleeding from the bottom; pus leaking from your piles; black or dark red poo; bloody diarrhoea	Ask for an urgent GP appointment or get help from NHS 111
Bleeding non-stop; a lot of blood, for example the toilet water turns red, or large blood clots; piles with severe pain	Go to A&E or call 999

From the NHS pages on piles and on bleeding from the bottom. Do not drive yourself to A&E: ask someone to drive you or call 999 for an ambulance, and bring any medicines you take.

Bleeding from the bottom is sometimes a sign of bowel cancer, which the NHS says is easier to treat if it's found early, so it's important to get bleeding checked; the NHS also says not to self-diagnose. Its list of bowel cancer symptoms includes changes in your poo that aren't usual for you, needing to poo more or less often than usual, losing weight without trying, and a lump in your tummy.

Separately, the NHS offers a bowel cancer screening home poo test (a FIT kit) every 2 years to people aged 50 to 74, because the risk of bowel cancer rises with age. It can find cancer before symptoms appear, and the NHS says to see your GP about symptoms that worry you, even after a clear screening result.

What happens when you see a GP about piles?

The GP will ask about your symptoms and may examine your bottom. NHS inform says there's no need to be embarrassed, as all GPs are used to diagnosing and treating piles. You can ask for a male or female doctor or nurse, and for someone else to be in the room during the examination, the NHS says.

ACPGBI describes the usual examination: you lie on your left side, the doctor looks at the skin around your back passage, then gently inserts a gloved finger, which ACPGBI says is much less painful than many people imagine. Many GPs also do a proctoscopy in the surgery, looking directly inside the anal canal; ACPGBI says it feels almost the same as the finger examination.

Tell the GP if you've recently lost a lot of weight, your bowel movements have changed, or your poo has become dark or sticky, NHS inform advises. The GP may ask for a poo sample or give you a home FIT test, prescribe stronger medicines for piles or constipation, or refer you for tests. They may also check that your symptoms are not being caused by something else.

What hospital treatments are there for piles?

If piles don't improve with home treatment, you may need hospital treatment. The NHS lists four treatments without surgery, done while you're awake and usually with a same-day return home, and three kinds of surgery, including piles removal (haemorrhoidectomy), for piles that are large or don't respond.

Without surgery:

• Rubber band ligation: a band is placed around the pile to make it drop off. NICE CKS calls it the best available outpatient treatment, and says about 2 in 10 people need a second banding within 6 months.
• Sclerotherapy: a liquid is injected into the pile to make it shrink.
• Electrotherapy: a gentle electric current is applied to make the pile shrink.
• Infrared coagulation: infrared light cuts the blood supply so the pile shrinks.

Surgery (you'll usually be asleep, and may go home the same day or the next):

• Haemorrhoidectomy: the piles are cut out. NICE CKS says it gives the best long-term effect, with symptoms coming back in less than 20%.
• Stapled haemorrhoidopexy: the piles are stapled back inside the anus.
• Haemorrhoidal artery ligation: stitches cut off the blood supply so the piles shrink.

Is it piles or something else?

Bleeding, itching, a lump and pain around the bottom all have other possible causes, and the NHS advises against diagnosing the cause yourself. These guides cover other causes of the same symptoms:

• Bleeding from your bottom: what the colour and amount of blood can mean, and when it's an emergency.
• Anal fissure: a small tear in the anus that, the NHS says, causes severe, sharp pain when you poo and a burning pain that may last several hours.
• Piles or anal fissure?: the two side by side, symptom by symptom.
• What piles look and feel like: internal and external piles, the four grades and clotted piles, described in words.
• Itchy bottom: the other causes of an itch, from sweating in hot weather to skin conditions.
• Pilonidal sinus: a small hole or tunnel at the top of the cleft between your buttocks, which the NHS says is more common in men because they tend to be hairier.
• Anal warts: the NHS describes genital warts as small, rough lumps that can appear around the anus, and a common sexually transmitted infection. A sexual health clinic (NHS GUM clinic) can check.

How can you prevent piles?

The habits that help piles settle also help stop them coming back. NICE CKS advises carrying on with a high-fibre diet and plenty of fluids after piles have healed, because recurrence is most likely when risk factors such as constipation and straining continue.

• Eat more fibre, building up gradually towards the 30g a day in government guidelines (NHS, NICE CKS).
• Drink plenty of fluids, and cut down on alcohol and caffeine (NHS).
• Go when you need to, without straining, and don't stay on the toilet longer than you need to (NHS).
• Rest your feet on a low stool when you poo, with your knees above your hips if possible (NHS).
• Keep active: a daily walk or run can help you poo more regularly (NHS).
• Keep to a healthy weight, since being overweight makes piles more likely (NHS).