Piles also known as hemorrhoids are normal part of the anal canal and have important role for continence of stools unless there is some abnormality associated with them. Piles are inflammed and swollen veins of the anal canal along with supportive tissue and elastic fibre as they are part of the anal sphincter. The size of the piles may vary.
Hemorrhoids or piles are swollen veins in the anus and lower rectum which may result from straining while passing stool or during pregnancy also due to increased pressure in these veins.
There are two anal sphincters viz. internal and external. Hemorrhoids may be located inside the rectum known as internal piles or may develop under the skin around the anus known as external hemorrhoids. Occasionally a clot may form in the external hemorrhoids known as thrombosed piles.
Internal piles: internal piles (around internal anal sphincter) are usually painless but usually bleed when they are irritated (by passage of hard stool). they can be of four grades.
Grades of internal piles:
Grade I - In grade I piles, there is just swelling of veins but no protrusion or prolapse of veins. Thus there is prominence of veins only.
Grade II - In grade II piles, the veins prolapse or protrude only on bearing down which reduce spontaneously on removal of pressure.
Grade III - In grade III piles, the veins are protruded on bearing down but don't reduce on their own and has to be pushed back manually.
Grade IV - In grade IV piles, the prolapsed veins can't be reduced even manually.
External piles: external piles are swelling of veins present outside the anus which may be painful sometimes and don't bleed usually. Common symptoms are irritation and itching.