Have you ever felt discomfort, itching, or pain around your anal area and wondered if piles may be the cause? Also known as haemorrhoids, piles are swollen veins in the rectum or anus that can make everyday activities like sitting or going to the toilet uncomfortable. They’re quite common and usually manageable, but knowing whether your piles are internal or external can make a real difference in how you approach treatment and recovery.
Read on as we explore the key differences between the two types, how they’re identified, and the signs that may indicate when it’s time to seek help.
What Are Internal Piles?
Internal piles develop inside the rectum and often go unnoticed in the beginning. Because this area contains very few pain-sensitive nerves, early-stage internal piles are usually painless. You may only realise something is wrong when you notice bright red blood after a bowel movement, or in more advanced cases, when a lump slips out through the anus, a condition known as a prolapsed pile.
Grading Internal Piles (Grades I–IV)
Doctors classify internal piles into four grades, depending on how far they have prolapsed and whether they can return to their normal position on their own. These grades help determine the best course of treatment.
- Grade I: Located entirely inside the rectum; may cause occasional bleeding but does not protrude.
- Grade II: May prolapse during straining or bowel movements but return inside on their own.
- Grade III: Prolapse happens more frequently, and the lumps need to be gently pushed back into the rectum.
- Grade IV: Permanently prolapsed and cannot be repositioned, often requiring surgical treatment.
What Are External Piles?
External piles are lumps that form under the skin around the anus. Because of their location, they tend to be more noticeable and more uncomfortable. Common signs include:
- Lumps or swelling around the anal opening
- Itching, tenderness, or pain, especially when sitting
- Sharp pain if a blood clot forms (thrombosed pile)
- Irritation from wiping, friction, or prolonged sitting
- Discomfort during bowel movements or daily activities
Key Differences Between Internal and External Piles
Although both types of piles share similar causes, their location and symptoms differ significantly. Understanding these differences helps you identify what you may be experiencing and when to seek medical advice.
Internal Piles
Internal piles develop inside the rectum and aren’t visible from the outside. They’re typically painless, even when bleeding occurs, because the area has few pain-sensitive nerves. Diagnosis usually involves an internal assessment, such as a digital rectal exam, anoscopy, or colonoscopy, to confirm their presence and rule out other causes of bleeding.
External Piles
External piles form around the anus and are easier to see and feel. Because this area is rich in pain-sensitive nerves, they can cause significant discomfort — particularly when sitting, wiping, or passing stool. Diagnosis is usually straightforward, involving a simple visual inspection and physical examination to check for swelling, inflammation, or blood clots.
If you’re dealing with rectal bleeding, ongoing pain, or any lumps or irritation around the anus, consulting a colorectal specialist is the best next step. A professional assessment not only identifies the type of piles but also rules out other conditions with similar symptoms, such as anal fissures or colorectal issues.
Our piles specialists in Singapore provide personalised care tailored to your symptoms and needs. Contact us today to schedule your consultation.
Frequently Asked Questions
Can internal piles turn into external piles?
No, internal and external piles form in different parts of the anal canal. However, internal piles can prolapse, meaning they slip out through the anus and may appear similar to external piles. While this can cause swelling and irritation, the underlying issue remains internal.
How long do external piles last?
Mild external piles often improve within a few days to a week, especially with home remedies and lifestyle adjustments like increasing fibre intake and staying hydrated. However, if a blood clot (thrombosis) develops, the pain and swelling may last longer and may require medical treatment. Persistent or painful external piles should always be evaluated by a doctor.
What causes bleeding in internal piles?
Bleeding often happens when straining during bowel movements or passing hard stools irritates the delicate veins in the rectum. Although it’s usually painless, regular bleeding should never be ignored; always have it checked by a healthcare professional to rule out other causes.
Can internal piles turn into external piles?
No, internal and external piles form in different parts of the anal canal. However, internal piles can prolapse, meaning they slip out through the anus and may appear similar to external piles. While this can cause swelling and irritation, the underlying issue remains internal.
Can pregnancy cause both types of haemorrhoids?
Yes. Pregnancy increases pressure in the pelvic area, which can lead to both internal and external piles, especially in the later stages or after childbirth. Hormonal changes, constipation, and straining during delivery can all contribute to their development.