Piles

Piles are also called hemorrhoids, in which swollen and inflamed veins located in or around the rectum and anus. These veins may enlarge due to pressure, irritation, or straining, which leads to pain, itching, discomfort, or bleeding during bowel movements.

Types of Piles

1. Internal Piles

Internal piles are swollen veins inside the rectum, usually located above the dentate line.
They are like varicose veins but occur inside the anal canal. They are covered by mucosa. They usually do not cause pain, especially in early stages.

Internal piles are classified into four grades:

Grade 1

Grade 1 internal piles are the earliest and mildest form of internal hemorrhoids. They involve small and swollen veins inside rectum. Usually prolapse are not visible swelling from outside. They are located above the dentate line, which is why they are usually painless. It causes painless bleeding.

Grade 2

Grade 2 internal piles are moderately enlarged hemorrhoidal veins located inside the rectum, which prolapse during bowel movements but go back inside on their own without manual assistance. They are more advanced than Grade 1 but less severe than Grade 3 and Grade 4.

Grade 3

Grade 3 internal piles are moderately to severely enlarged internal hemorrhoids that prolapse outside the anus during bowel movements or straining and do NOT go back inside on their own. They must be manually pushed back into the anal canal. They are more advanced than Grade 1 and 2, but less severe than Grade 4.

Grade 4

Grade 4 internal piles are the most severe and advanced stage of internal hemorrhoids.
They involve large, swollen internal veins that are permanently prolapsed. They remain outside the anus all the time and cannot be pushed back inside, even manually. These hemorrhoids require urgent medical attention and usually surgical treatment.

Symptoms of Internal Piles

• Bright red blood during stool

• Mucus discharge

• Feeling of incomplete bowel movement

• Painless swelling inside the rectum

• Lumps coming out during stool

2. External Piles

External piles are swollen veins located under the skin around the anus, specifically below the dentate line. These are covered by skin, which contain pain receptors. External piles can be painful, especially if complications occur. Due to irritation of the skin and mucus leakage, itching may occur.

Most cases improve with home treatments, but thrombosed external piles may need minor procedures for fast relief.

Symptoms of External Piles

• Painful swelling or lump near the anus

• Pain while sitting or passing stool

• Itching and irritation while sitting

• Bleeding during wiping or bowel movements

• Tenderness around the anus

• Moisture or mucus leakage

Symptoms of Thrombosed Piles

• Sudden severe pain

• Hard lump outside anus

• Swelling & bluish color near the anus

• Difficulty in sitting or walking

Causes for Piles

1. Constipation Related Causes

Constipation is one of the major causes of piles, mainly because it leads to straining.

Chronic Constipation

• Hard stools make bowel movements difficult

• You push harder which increases the pressure on rectal veins

• This pressure causes veins to swell, leading to hemorrhoids

Straining During Bowel Movements

• Straining significantly increases pressure inside the lower rectum

• This is one of the leading causes of piles

Low-Fiber Diet

• Low fiber diet is always responsible for hard stools which cause constipation with staining

• This cycle increases the likelihood of hemorrhoids

Holding Stool

• Delaying bowel movements causes more water absorption in the colon

• Stools become drier and harder to pass causes more straining

Prolapsed Hemorrhoids Can Worsen Constipation

• Larger internal piles can obstruct stool passage which worsens constipation in a loop

2. Sedentary Lifestyle Related Causes

A sedentary lifestyle, long hours of sitting or inactivity plays a major role in piles.

Prolonged Sitting

• Sitting too long increases pressure on the anal and rectal veins

• This makes veins swell, promoting hemorrhoids

Sitting on the Toilet for Long Periods

• The toilet seat opening and gravity puts even more pressure on the rectal veins

• This worsens swelling and irritation

Lack of Physical Activity

• Low movement slows digestion which increases constipation risk

• Poor circulation contributes to vein swelling

General Sedentary Lifestyle Risk

• Sedentary habits are recognized as a clear risk factor for hemorrhoids

Main reason behind various types of piles is the veins in the rectum or anus become swollen due to pressure, straining, or poor bowel habits. In chronic constipation, hard stools and difficulty passing stools force you to strain. This increases pressure on rectal veins and causes swelling. Pushing too hard during toilet use is one of the biggest causes of piles. Hence staining during bowel movements occurs.

Frequent loose motions also irritate and inflame rectal veins which cause chronic diarrhea. Sitting for long periods on the toilet increases pressure on the anal blood vessels and can lead to hemorrhoids. Low-fiber diet means a diet lacking fruits, vegetables, and whole grains that cause constipation and hard stools.

Obesity increases pressure on pelvic and rectal veins. During pregnancy hormonal changes relax blood vessels. The growing uterus adds pressure on veins. Hence piles more common in pregnant women. Lifting heavy weights repeatedly increases abdominal pressure, leading to swelling of rectal veins. An inactive lifestyle slows digestion, leading to constipation and increased pile risk. Some people inherit weak vein walls, which cause piles. Dehydration makes stools hard and difficult to pass. Poor digestion leads to toxin which causes constipation. Tissues around the anus weaken with age, which causes piles.

Arsha in Ayurveda

In Ayurveda, Arsha refers to swollen, engorged, painful masses in the anal region, equivalent to piles/hemorrhoids.

Ayurveda describes Arsha as one of the most distressing diseases because it affects both food intake and elimination. Arsha is the result of veins and tissues in the anal canal becoming swollen, protruding, and painful.

Causes of Arsha

1. Agnimandya
   Due to poor digestion, forms of toxins which block anal vessels occur swelling at anus

2. Vata Prakopa
   Vata is the primary dosha responsible for Arsha

3. Pitta Aggravation
   Due to pitta aggravation bleeding piles, burning, inflammation, heat sensation in anus occurs

4. Kapha Aggravation
   Kapha aggravates mucus discharge, heaviness, soft, bulky swelling

Types of Arsha in Ayurveda

• Vataja Arsha
  Dry, hard stools, severe pain, rough swelling, and constipation

• Pittaja Arsha
  Bright red bleeding, burning sensation, heat aggravation, red inflamed swelling

• Kaphaja Arsha
  Pale bulky swelling, mucus discharge, heaviness

• Sannipataja Arsha
  All three doshas aggravated, severe symptoms

• Raktaja Arsha
  Excessive bleeding occurs

• Sahaja Arsha
  Inherited weak vein walls

Symptoms of Arsha

• Pain during defecation

• Bleeding during wiping or bowel movements

• Swelling at anal region

• Itching and irritation while sitting

• Mucus discharge

• Feeling of incomplete evacuation

Ayurvedic Herbs for Arsha

1. Triphala

Triphala is one of the most important Ayurvedic formulations for piles. It is made of:

• Haritaki helps to improve bowel movements

• Bibhitaki removes accumulated waste

• Amalaki provides lubrication and moisture

Triphala is described as Rasayana. It rejuvenates the digestive system, cleanses the colon, and balances the doshas. It helps to soften stool and relieve constipation. It clears aama gently and reduces pain and pressure on pile masses.

Dosage:

• Take one tablespoon at night with warm water

• Take half tablespoon if stools become too loose

• Tablets: one or two at night, under expert guidance

2. Haritaki

Haritaki lubricates the intestine, reduces dryness, and supports smooth evacuation. It treats the root cause: constipation and Vata imbalance. It reduces pain, inflammation, and supports healing.

Dosage:

• Half or one tablespoon with warm water at night

3. Nagkesar

Nagkesar is useful for bleeding piles and inflammation. It helps reduce bleeding, strengthens blood vessels, and controls pitta.

Common formulations:

• Kankayan Vati

• Arshoghni Vati

Ayurveda focuses on root cause removal rather than temporary relief. Many cases of piles can be cured without surgery.

Author

Swashri Ghorpade
Maternal & Child Nutritionist
18 March 2026

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