What do piles look like? The NHS describes piles (haemorrhoids, or hemorrhoids in US spelling) as lumps inside and around your bottom (anus). What you see or feel can depend on the kind you have. The Association of Coloproctology of Great Britain and Ireland (ACPGBI) describes internal piles that stay inside, prolapsing piles that come down when you poo, and external piles that are out all the time.
This guide describes each kind in words rather than pictures. If you'd like to see photographs, the NHS piles page, listed in the sources below, has some.
What do piles look like from the outside?
Piles you can see look like lumps around the anus. The NHS says they can be pink or purple, and range from small lumps around the size of a pea to larger lumps the size of grapes. NICE CKS, NICE's guidance for GPs, says internal piles that have come down may look like bluish, soft, bulging swellings covered by the lining of the back passage.
An external pile that isn't causing trouble may show only as a bluish bulge under the skin, according to NICE CKS. Internal piles that stay inside can leave the area around the anus looking normal; when a doctor looks inside with a proctoscope, they appear as pink swellings of the lining. And NHS inform says that in many cases piles cause no symptoms, so some people don't realise they have them.
What do piles feel like?
Piles can feel like a lump at your anus, an itch, soreness, or a feeling that you haven't finished pooing. The NHS lists an itchy anus, pain around the anus, lumps, mucus in your underwear or on toilet paper, and feeling like you still need to poo after going to the toilet. NICE CKS adds a feeling of fullness or discomfort in the back passage.
NICE CKS says that feeling of fullness may be present when piles come down as you strain and in people with large piles, and that soiling from mucus may also occur. Itching can come from piles that come down and leave the area moist, or from external piles and skin tags that make the area harder to keep clean.
Do piles hurt?
ACPGBI says piles often cause discomfort but are not very often acutely painful. NICE CKS explains why. Internal piles sit where the lining has no pain fibres, so they don't hurt unless they come down and get strangulated. External piles sit under skin rich in pain fibres, so they can itch and hurt, and become acutely painful if a clot forms.
What is the difference between internal and external piles?
Internal piles start inside the anal canal, above the dentate line, which sits 2cm in from the edge of the anus, where the lining has no pain fibres. External piles start below that line, under skin that is rich in pain fibres, so they can be itchy and painful. NICE CKS says you can have both at the same time.
ACPGBI groups them by what they do. Internal piles stay inside and may cause no symptoms, though they are a frequent cause of bleeding. Prolapsing piles are large enough to come down when you poo, then spring back or need pushing back. External piles are out all the time.
Where piles form
- 1 Rectum, the lower end of the bowel
- 2 Internal pile, starting inside the back passage
- 3 External pile, under the skin around the anus
- 4 Anal sphincter muscles
- 5 Anal canal
Illustration made with AI for education. Simplified, not to scale.
What are the grades of internal piles?
Doctors grade internal piles from 1 to 4 by how far they come down (prolapse). In NICE CKS, grade 1 piles stay inside the anal canal; grade 2 come out when you strain but go back by themselves; grade 3 come out and go back fully when pushed; grade 4 stay outside and cannot be pushed back.
| What happens | What you might notice | |
|---|---|---|
| Grade 1 internal pile | Stays inside the anal canal | The skin around the anus may look normal; it may bleed bright red |
| Grade 2 internal pile | Comes out when you strain, then goes back by itself | A lump when you strain that goes back when you stop |
| Grade 3 internal pile | Comes out and goes back fully when pushed | A soft, bluish lump at the anus that you can gently push back |
| Grade 4 internal pile | Stays outside and cannot be pushed back | A lump that stays out; NICE CKS advises GPs to refer these for non-urgent assessment |
| External pile | Starts under the skin around the anus | A lump that can itch or hurt, or a bluish bulge under the skin |
| Thrombosed (clotted) external pile | A blood clot forms in an external pile | A purplish, swollen, tense, tender lump that can be acutely painful |
| Skin tag | A flap of skin around the back passage | Very common; often no trouble, but it can swell and hurt from time to time |
Grades and descriptions from NICE CKS (guidance for GPs); types and skin tags from ACPGBI. The grade does not always reflect how bad the symptoms are.
The four grades of internal piles
- 1 Grade 1: stays inside the anal canal
- 2 Grade 2: comes out when you strain, then goes back by itself
- 3 Grade 3: comes out and goes back when pushed
- 4 Grade 4: stays outside and cannot be pushed back
Illustration made with AI for education. Simplified, not to scale.
What does a prolapsed pile look like?
A prolapsed pile, or prolapsed hemorrhoid, is an internal pile that has come down outside the anus. NICE CKS says prolapsed piles may look like bluish, soft, bulging swellings covered by the lining of the back passage, and straining may make them appear at the anus. Grade 2 piles go back by themselves, grade 3 need gently pushing back, and grade 4 stay out.
The NHS suggests gently pushing a pile back inside if you can. A prolapsed pile that can't be pushed back into the anal canal can cause severe pain, NICE CKS says, and the NHS says to go to A&E or call 999 if you have piles and are in severe pain. A rectal prolapse can also show as a lump that sticks out, NICE CKS notes, and a GP's examination helps rule it out.
What does a thrombosed pile look like?
A thrombosed pile, or thrombosed hemorrhoid, is a pile with a blood clot in it. NICE CKS says a clotted external pile may look like a purplish, swollen, tense, tender lump under the skin around the anus, and it can be acutely painful. The pain usually peaks 48 to 72 hours after it starts and settles by itself within 7 to 14 days, NICE CKS says.
NICE CKS also mentions a perianal haematoma, a blue or dark-coloured swelling at the edge of the anus. NICE CKS advises GPs to consider hospital admission for an extremely painful clotted pile seen within 72 hours of it starting, so a very painful new lump is worth showing a GP promptly. If the pain is severe, the NHS says go to A&E or call 999.
What else can be mistaken for piles?
Several things can look or feel like piles, and NICE CKS warns that even when piles are seen, another problem may be present too. ACPGBI says lumps around the back passage are much more likely to be skin tags than piles. The other look-alikes NICE CKS lists include warts, a fissure, an abscess, a fistula, a rectal prolapse and cancer.
- Skin tags: flaps of skin around the back passage. ACPGBI says they are very common, are different from external piles, and are often what people call their piles.
- Anal warts: the NHS describes genital warts as small, rough lumps that can appear around the anus, and a common sexually transmitted infection. NICE CKS notes warts can resemble skin tags. A sexual health clinic (NHS GUM clinic) can check, and our guide to anal warts explains more.
- Anal fissure: a small tear in the anus with sharp pain when you poo, the NHS says. A long-lasting fissure can have a small skin tag at its end, according to NICE CKS. Our guide to piles or anal fissure sets out the differences.
- Abscess or fistula: NICE CKS says an abscess can cause pain, swelling, fever, marked tenderness and redness, and the NHS links constant throbbing pain, pus and a high temperature to anal abscesses and fistulas. Severe pain with a high temperature needs an urgent GP appointment or NHS 111.
- Pilonidal sinus: a small hole or tunnel at the top of your bottom, between your buttocks, the NHS says. See our pilonidal sinus guide.
When should you see a GP about piles?
See a GP if your symptoms 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, the NHS says. A new lump or bleeding is worth a proper check, because other conditions can look like piles.
NHS inform says GPs are used to diagnosing and treating piles. Tell your 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 NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have piles and:
- your temperature is very high, or you feel hot, cold or shivery and generally unwell
- you have painless bleeding from the bottom
- pus is leaking from your piles
Go to A&E or call 999 if you have piles and:
- you are bleeding non-stop
- there is a lot of blood or you see large blood clots
- you are in severe pain
For what helps at home and the treatments a GP or hospital can offer, see our guide to piles in men; for bleeding in more detail, see bleeding from your bottom.
Common questions
Can you feel internal piles?
Often not. NICE CKS says the lining over internal piles has no pain fibres, and that a doctor's finger can't feel internal piles either, so they are found by looking with a proctoscope. You may notice them through bleeding, or as a lump if they come down.
Are piles hard or soft?
NICE CKS says piles that have come down may look like bluish, soft, bulging swellings. A clotted (thrombosed) pile may be a tense, tender lump.
What colour are piles?
The NHS says piles can be pink or purple. NICE CKS says they may look bluish, or purplish when a clot has formed.
How big can piles get?
The NHS says they range from small lumps around the size of a pea to larger lumps the size of grapes.
Do piles go away on their own?
Often, yes: the NHS says piles often get better on their own after a few days. The pain of a clotted pile usually settles by itself within 7 to 14 days, NICE CKS says.
How do you know if it's piles or something else?
You can't always tell by yourself. NICE CKS says the symptoms of piles are non-specific and can be seen in a number of other conditions, and the NHS says not to self-diagnose. A GP can check by asking about your symptoms and examining your back passage.
Is a skin tag the same as a pile?
No. ACPGBI says skin tags are flaps of skin around the back passage, different from external piles, though they are often what people call their piles. NICE CKS says skin tags can form after piles swell and clot repeatedly.
Sources
- NHS: Piles (haemorrhoids)
- NHS inform: Piles (haemorrhoids)
- NICE CKS: Haemorrhoids, what are haemorrhoids?
- NICE CKS: Haemorrhoids, diagnosis
- NICE CKS: Haemorrhoids, complications
- NICE CKS: Haemorrhoids, what else could it be?
- NICE CKS: Haemorrhoids, management
- NICE CKS: Anal fissure, diagnosis
- ACPGBI: Haemorrhoids (piles)
- NHS: Anal fissure
- NHS: Anal pain
- NHS: Genital warts
- NHS: Pilonidal sinus
How this page was made. We wrote it from the sources listed above, opening and reading every one, and it says no more than they do. It's general information for adults, not medical advice, and it doesn't replace a GP or pharmacist. If you're worried about a symptom, speak to one of them or call NHS 111. In an emergency, call 999.