I. Internal Haemorrhoids or Piles : Internal hemorrhoids which also include the interoexternal piles (hemorrhoids) are very common. Symptoms usually include:

  • Bleeding is the earliest symptom. Earlier the bleeding is slight and bright red in color and occurs with passage of stool.
  • The Degree or stages of piles (hemorrhoids)  
    • First degree piles (hemorrhoids)  when the anal lining is not visible outside i.e. the piles (hemorrhoids) do not bulge out (prolapse) of the anal canal.
    • Second degree – Continuous straining or pressure can cause the anal lining to protrude out of the anal canal. These type of piles (hemorrhoids) bulge out only while passing stool. In the beginning the piles (hemorrhoids)recede back on their own but with the progress of the condition they may have to be replaced by hand.
    • Third degree – These piles (hemorrhoids) may prolapse during anytime of the day (i.e. not just while passing stool). The piles (hemorrhoids) may remain prolapsed (bulged out) permanently and cause a feeling of discomfort and heaviness in the rectum.
  • A slimy whitish (mucoid) discharge, frequently accompanies the protrusion of the anal lining.
  • Itching or general discomfort in and around the anus.
  • Soiling of the undergarments.
  • Pain is usually absent unless there are complications. Pain can be a result of any other condition along with internal piles(hemorrhoids).
  • Anemia is rare but can be due to persistent heavy bleeding from the internal piles (hemorrhoids).

II. External Haemorrhoids or Piles : External piles appear suddenly due to straining while passing stools, constant coughing, or lifting heavy weights which causes the blood to collect in the veins around the anal region which therefore swell up. They may present as:

  • Dilatation of the veins related to anus : This is common in people leading a sedentary lifestyle. A bluish cushion- like ring around anus appears while straining at stool.
  • A thrombosed external hemorrhoid or pile : Commonly known as Perianal haematoma. It is a small clot which occurs outside of the anal canal on the anus.The condition is very painful and appears all of a sudden. If untreated, it might suppurate (pus formation), fibrose and might give rise to a tissue tag, or it may burst or continue to bleed.
  • Sentinel piles (hemorrhoids) : The form of piles known as sentinel piles is commonly seen with anal fissure (painful longitudinal ulcer).
  • Associated with internal piles (Interoexternal pile) : The presentation is same as described in Internal piles (hemorrhoids).