Disease should be thought of as pile tissue that causes significant symptoms. Unfortunately, piles tend to get worse over time, and disease should be treated as soon as it occurs. Proposed causative factors include constipation, prolonged straining, derangement of the internal anal muscle, and pregnancy. Piles may be caused by more than one factor. Piles can be either internal or external, and patients may have both types.
External piles occur below the dentate line and are generally painful.
When inflamed they become red and painful, and if they become clotted, they can cause severe pain and be felt as a painful mass in the anal area. Internal piles are located above the dentate line and are usually painless. Dentate line is a line seen in the anal canal that demarcates the area with pain sensation from that without it. Piles that remain prolapsed may develop thrombosis and gangrene. The diagnosis is made by examining the anus and anal canal, and it is important to exclude more serious causes of bleeding, such as cancer.