Piles (buasir): symptoms, internal vs external, treatment and when bleeding is serious
Piles (buasir, haemorrhoids or hemorrhoids) are swollen blood vessels in and around the anus. They are very common, are rarely dangerous, and often settle on their own within a few days. But bleeding from the bottom can also be a sign of bowel cancer, which in Malaysia is often found late. Here is how to tell the difference, what helps, and when to see a doctor.
Key points
- Internal piles sit inside the back passage and are usually painless but can bleed. External piles sit under the skin around the anus and can itch and hurt.
- Typical signs are bright red blood on the tissue or in the toilet after a bowel movement, itching, mucus, and a soft lump at the anus.
- Most piles improve within a week with more fibre (25–38 g a day), plenty of water, not straining, and warm sitz baths.
- Piles that keep coming back can be treated in a clinic with banding, without an operation. Surgery is for large piles that stay outside.
- See a doctor about any bleeding from the bottom if you are over 40, if your bowel habit has changed, if the blood is dark, or if you are losing weight or feel tired. These can be signs of bowel cancer.
What are piles (buasir)?
Everyone has cushions of blood vessels in the anal canal. They become piles when they swell and stretch, usually because of pressure from straining.
- Internal piles (buasir dalam) form inside the back passage. They are usually painless, because the lining there has few pain nerves, but they can bleed and can slip out (prolapse).
- External piles (buasir luar) form under the skin around the anus. They can itch, feel sore and sometimes bleed.
- A thrombosed external pile is one with a blood clot inside. It appears suddenly as a very painful, purple or bluish lump. The clot stays in the pile and doesn’t travel elsewhere in the body.
The four grades of internal piles
| Grade | What happens |
|---|---|
| Grade 1 | Stays inside, may bleed |
| Grade 2 | Comes out when you pass stool, then goes back by itself |
| Grade 3 | Comes out (buasir terkeluar) and has to be pushed back with a finger |
| Grade 4 | Stays outside and can’t be pushed back |
Symptoms of piles (tanda buasir)
- bright red blood on the toilet paper, on the surface of the stool or dripping into the toilet after a bowel movement
- itching or irritation around the anus
- a soft lump at or outside the anus
- mucus in your underwear or on the toilet paper
- a feeling that you still need to go after emptying your bowels
- pain, mainly with external or thrombosed piles
Other conditions cause similar symptoms. An anal fissure (a small tear) causes sharp pain during and after passing stool, often with a little bright blood. An abscess causes a painful swelling with fever. A doctor can usually tell the difference with a quick examination.
What causes piles? (Punca buasir)
- straining on the toilet, often because of constipation from a low-fibre diet or not drinking enough
- sitting on the toilet for a long time, for example scrolling on a phone
- long-term diarrhoea
- pregnancy and childbirth
- being overweight
- regular heavy lifting
- getting older, as the supporting tissue weakens
When bleeding could be something serious
Piles are the most common cause of bright red bleeding, but not the only one. Bowel (colorectal) cancer can also cause bleeding, and in Malaysia it is often found late. In a National Cancer Registry study of more than 5,600 patients, about 7 in 10 were diagnosed at stage 3 or 4, and doctors report that symptoms in younger adults are often dismissed as piles.
See a doctor soon if you have bleeding from the bottom and:
- you are 40 or over, or have a family history of bowel cancer
- your bowel habit has changed, such as looser stools or constipation that lasts several weeks
- the blood is dark red or black, or mixed into the stool
- you are losing weight without trying, feel very tired or breathless (signs of anaemia), or have tummy pain or a lump
- the bleeding continues after your piles have been treated
The doctor may examine your bottom and arrange a colonoscopy to look inside the bowel. See our guide to bowel cancer symptoms and free screening.
Go to a hospital emergency department if you are passing a lot of blood or large clots, the bleeding won’t stop, or you feel faint. See our guide on clinic or emergency department.
How to treat piles at home
Most piles get better within a few days to a week with simple steps, and these also help stop them coming back:
- Eat more fibre: aim for 25–38 g a day from vegetables, fruit, oats, wholemeal bread, brown rice, beans and lentils. Increase it gradually. A fibre supplement such as psyllium (ispaghula) helps if your diet falls short.
- Drink plenty of water so stools stay soft.
- Don’t strain, go when you feel the urge, and don’t sit on the toilet for more than a few minutes. Leave your phone outside.
- Sitz bath: sit in a few inches of warm (not hot) water for 10–20 minutes, once or several times a day, especially after a bowel movement. It soothes pain and itching.
- Keep the area clean with water and pat it dry rather than rubbing with dry tissue.
- Use a cold compress wrapped in a cloth for swelling.
- Pain relief: paracetamol is usually fine. Avoid painkillers containing codeine, which cause constipation, and avoid ibuprofen if your piles are bleeding.
Piles creams and medicines (ubat buasir)
- Creams, ointments and suppositories from a pharmacy can ease itching, pain and swelling for a short time. Some contain a mild steroid or a local anaesthetic. Don’t use steroid products for more than a week unless a doctor tells you to, as they can thin the skin.
- Flavonoid tablets (also called phlebotonics, such as micronised purified flavonoid fraction) are widely used in Malaysia. A Cochrane review found they reduced bleeding and itching, although the trials were of limited quality.
- Laxatives that soften the stool, such as fibre supplements, help if you are constipated.
Check the product is registered. Medicines and traditional or herbal products sold in Malaysia must be registered with the National Pharmaceutical Regulatory Agency (NPRA) and carry a MAL number. Unregistered products, often sold online with promises of “piles shrinking in days”, have been found to contain hidden prescription drugs. You can check a product on the NPRA website.
Treatment at a clinic or hospital
If piles keep bleeding or coming out despite home treatment, a doctor may refer you to a surgeon:
| Treatment | What it involves | Usually for |
|---|---|---|
| Rubber band ligation (banding) | A tight band placed around the base of the pile, which drops off within about a week. Done while you are awake, with no cuts | Grade 1 to 3 internal piles |
| Injection (sclerotherapy) or infrared coagulation | An injection or heat to shrink the pile, done while you are awake | Small internal piles |
| Haemorrhoidectomy | An operation to cut the piles away, usually under general anaesthetic | Grade 3 and 4 piles, or large internal and external piles |
| Haemorrhoidal artery ligation or stapling | Operations that cut off the blood supply to the piles or lift them back into place | Selected cases; less pain, but piles come back more often |
- Recovery after a haemorrhoidectomy usually takes 2 to 4 weeks, and the first bowel movements are the most painful. Stool softeners and sitz baths help.
- A thrombosed external pile that is very painful can be cut open to remove the clot if you are seen within about 2 to 3 days. After that, it usually settles on its own within a couple of weeks.
- Piles can come back after any treatment, so the fibre, water and no-straining habits still matter.
Piles in pregnancy and after childbirth
Piles are common in late pregnancy and after giving birth, because of pressure from the baby, hormones, constipation and pushing during labour. In one study of 280 pregnant women, more than 4 in 10 developed piles or a similar problem, mostly in the third trimester or after delivery.
- Eat plenty of fibre, drink water and stay active to prevent constipation.
- Use a cold compress or sitz bath for comfort.
- Check with your doctor, midwife or pharmacist before using any cream or tablet.
Piles that start in pregnancy often improve within weeks of the birth.
Where to get piles checked
A GP can examine you, tell piles apart from other causes of bleeding, prescribe treatment and refer you for banding, surgery or a colonoscopy if needed. Our directory lists GP clinics across Kuala Lumpur, Selangor and other states, including clinics open in the evening and at weekends.
Browse the clinic directoryFrequently asked questions
What is buasir in English?
Buasir is piles, also called haemorrhoids (or hemorrhoids in American English): swollen blood vessels in and around the anus.
What are the signs of piles?
Bright red blood after a bowel movement, itching, mucus, a soft lump at the anus and, with external piles, pain.
How long do piles take to go away?
Mild piles often settle within a few days to a week with more fibre, water and less straining. A thrombosed external pile can take a couple of weeks.
What is the difference between internal and external piles?
Internal piles are inside the back passage and usually painless but may bleed or slip out. External piles are under the skin around the anus and can itch and hurt.
Can piles turn into cancer?
No, piles don’t turn into cancer. But bowel cancer can cause similar bleeding, so see a doctor about bleeding if you are 40 or over or have other warning signs.
Do piles need surgery?
Most don’t. Piles that keep bleeding or prolapsing can often be treated with banding in a clinic. Surgery is mainly for large piles that stay outside.
Is a sitz bath good for piles?
Many people find a warm sitz bath for 10–20 minutes soothes pain and itching, although the evidence for it is limited.
Which ubat buasir can I buy at a pharmacy?
Pharmacies sell creams, suppositories, fibre supplements and flavonoid tablets for piles. Ask the pharmacist, use steroid creams for no more than a week, and choose products with a MAL registration number.
Sources
- NHS — Piles (haemorrhoids) (reviewed Apr 2026)
- NHS — Piles treatment (reviewed Apr 2026)
- Cleveland Clinic — Hemorrhoids (May 2025)
- American Family Physician — Hemorrhoids: diagnosis and treatment options (2018)
- American Family Physician — Management of hemorrhoids: guidelines from the ASCRS (Dec 2025)
- Cochrane — Phlebotonics for haemorrhoids
- Frontiers in Oncology — Colorectal cancer survival among the Malaysian population (2023)
- The Star — Colorectal cancer in young Malaysians (15 Sep 2026)
- NPRA — Product registration FAQ
- Poskus et al. — Perianal diseases in pregnancy and after childbirth (BJOG, 2014)
