Diagnosis A doctor can usually diagnose piles after carrying out a physical examination. They will examine the anus of the person with suspected piles. The doctor may ask the following questions: Do any close relatives have piles? Has there been any blood or mucus in the stools? Has there been any recent weight loss? Have bowel movements changed recently? What color are the stools? For internal piles, the doctor may perform a digital rectal examination (DRE) or use a proctoscope. A proctoscope is a hollow tube fitted with a light. It allows the doctor to see the anal canal up close. They can take a small tissue sample from inside the rectum. This can then be sent to the lab for analysis. The physician may recommend a colonoscopy if the person with piles presents signs and symptoms that suggest another digestive system diseases, or they are demonstrating any risk factors for colorectal cancer. Treatments In the majority of cases, piles resolve on their own without the need for any treatment. However, some treatments can help significantly reduce the discomfort and itching that many people experience with piles. Lifestyle changes A doctor will initially recommend some lifestyle changes to manage piles. Diet: Piles can occur due to straining during bowel movements. Excessive straining is the result of constipation. A change in diet can help keep the stools regular and soft. This involves eating more fiber, such as fruit and vegetables, or primarily eating bran-based breakfast cereals. A doctor may also advise the person with piles to increase their water consumption. It is best to avoid caffeine. Body weight: Losing weight may help reduce the incidence and severity of piles. To prevent piles, doctors also advise exercising and avoiding straining to pass stools. Exercising is one of the main therapies for piles. Medications Several medicinal options are available to make symptoms more manageable for an individual with piles. Over-the-counter (OTC) medications: These are available over-the counter or online. Medications include painkillers, ointments, creams, and pads, and can help soothe redness and swelling around the anus. OTC remedies do not cure piles but can help the symptoms. Do not use them for more than 7 days in a row, as they can cause further irritation of the area and thinning of the skin. Do not use two or more medications at the same time unless advised to by a medical professional. Corticosteroids: These can reduce inflammation and pain. Laxatives: The doctor may prescribe laxatives if a person with piles suffers from constipation. These can help the person pass stools more easily and reduce pressure on the lower colon. Surgical options Around 1 in 10 people with piles will end up needing surgery. Banding: The doctor places an elastic band around the base of the pile, cutting off its blood supply. After a few days, the hemorrhoid falls off. This is effective for treating all hemorrhoids of less than grade IV status. Sclerotherapy: Medicine is injected to make the hemorrhoid shrink. The hemorrhoid eventually shrivels up. This is effective for grade II and III hemorrhoids and is an alternative to banding. Infrared coagulation: Also referred to as infrared light coagulation, a device is used to burn the hemorrhoid tissue. This technique is used to treat grade I and II hemorrhoids. Hemorrhoidectomy: The excess tissue that is causing the bleeding is surgically removed. This can be done in various ways and may involve a combination of a local anesthetic and sedation, a spinal anesthetic, or a general anesthetic. This type of surgery is the most effective for completely removing piles, but there is a risk of complications, including difficulties with passing stools, as well as urinary tract infections. Hemorrhoid stapling: Blood flow is blocked to the hemorrhoid tissue. This procedure is usually less painful than hemorrhoidectomy. However, this procedure can lead to an increased risk of hemorrhoid recurrence and rectal prolapse, in which part of the rectum pushes out of the anus.