What are the symptoms?

When piles flare up, they can cause itching, burning, pain, swelling and bleeding. They may seriously impair quality of life, as they become worse.

There are the typical symptoms for internal hemorrhoids:


  • bright red blood during and after bowel movement and on toilet paper
  • prolapse when internal hemorrhoids go or stay outside the anus
  • un-painful swelling from anal canal
  • an itching or burning sensation in the anal region, especially
    while sitting and during the night
  • secretion

There are the typical symptoms for external hemorrhoids:


  • permanent pain, increasing when sitting
  • painful margin swelling
  • un-painful swelling from anal margin

It is important to know that very frequent bleeding may also lead to anemia, i.e. a deficiency of red blood cells.But anemia associated with hemorrhoids is rare and needs systematic intestinal explorations.

First degree: Symptoms may occur

Hemorrhoids bleed, but do not prolapse. They are only seen at proctoscopy.

Second degree: Symptoms increase

Hemorrhoids protrude beyond the edge of the anal orifice during straining at stool and show spontaneous reposition when straining ceases. (Symptoms at this stage may consist of bleeding, itching, burning, and weeping.)

Third degree: Hemorrhoids do not retract on their own

Hemorrhoids protrude on straining and require manual reposition. Typical symptoms, such as bleeding, weeping and secretion of mucous material, become stronger.

Fourth degree: Permanent prolaps

Hemorrhoids are permanently prolapsed and partially fixed outside the anocutaneous line, no reposition possible. A typical symptom is anal itching caused by impaired continence.