Our anorectal region has a lot of veins. They act as a cushion for the area when stool is passed. However, when we frequently face constipation, these veins along with the tissue in the anal area become inflamed and swollen. This leads to piles or haemorrhoids.

They vary in size and can be external or internal.

External piles are formed on the outer edge of the anus while internal piles are formed 2-4 cms above the anal opening. The latter is the most common type of piles.

Based on the grade, the diagnosis of piles and its treatment changes. There are four grades of piles:

• Grade 1: When the inflammation is small, not visible to the eye, and present on the inner lining of the anus.
• Grade 2: These are larger than Grade 1 piles and are internal. They are pushed out when you pass stools but will return without any issue.
• Grade 3: Also called prolapsed haemorrhoids, these piles appear externally. They can be felt like a hanging mass but can be re-inserted.

• Grade 4: These piles are very large and cannot be re-inserted. They need consistent piles treatment, to manage them.