What are piles and how do I get them?
Piles (also known as haemorrhoids) are swollen blood vessels inside and around your arse. When the pressure inside these vessels is increased – usually by straining when going to the toilet – they enlarge and can form small lumps.

Piles may start as an itchy feeling in your arsehole but can become painful and cause bleeding. While this can sometimes make it painful to get fucked, piles are not considered a major health concern as they can usually be successfully treated.

Anyone can get piles and about 50% of people will have piles at some time in their life [1]. Piles vary in size and can occur inside or outside the arse. Piles found inside the arse are classified using a grading system: 

• Grade one piles are very common and are so small they are often missed. 
• Grade two piles are larger and, although they are inside your arse, they can sometimes come out a bit when you have a shit. They go back in immediately after though. 
• Grade three piles can be felt outside your arse. You may be able to feel one or more small lumps poking out. You'll usually be able to push them back inside using your finger. 
• Grade four piles are large and can remain outside your arse. They cannot be pushed back inside and will need to be treated by your GP.

Piles can also develop on the outside edge of the arsehole. They can become very itchy. This type of piles is less common. You can't catch piles from someone else.

How do I prevent it?
Piles usually appear after an increase in pressure in the blood vessels inside your arse. This usually happens when you strain for a shit or push something out of your arse.Things that increase your chances of having piles include being overweight, constipation, prolonged diarrhoea, lifting heavy weights, and if you are over the age of 50. You can't guarantee you'll never get piles but a good diet helps you to avoid them. A high-fibre diet will help you to reduce your risk of being constipated so you can avoid straining on the toilet. Gradually increase the amount of fibre you eat, as your stomach needs time to adapt. Doctors also recommend not waiting if you need to go to the toilet, as the delay can make constipation more likely.

How do I know I've got it?
The first sign of piles is usually itching around your arsehole. They can also make your arse feel sore and it may be visibly redder. You might notice some blood and mucus in the toilet after you shit. If the piles get worse, you may notice lumps inside and around your arsehole. If your piles get painful, you should see a doctor (your GP). Your doctor will look at your arse to check if the blood vessels are swollen.

How do I treat it?
In most cases, piles will go away by themselves within a few days. There are a number of treatments that can help if they are too uncomfortable.

• Sitting in a bath of warm water can help reduce the itching
• Cold compresses, like an ice pack, can help if hold the ice pack against your anus for no more than 30 minutes at a time to relieve pain
• Try pushing them in with your finger if the piles poke outside your arse, but are small enough to push back in without causing pain
• Cleaning your arse with moist toilet paper instead of dry toilet paper
• Using over-the-counter haemorrhoid creams – ask you pharmacist or GP who can prescribe creams that relieve irritation
• For more severe piles, your doctor may recommend surgical procedures. 'Banding' involves your doctor putting a tight elastic band around the small lumps inside your arse. After about a week, the piles should fall off. It can be uncomfortable for a day or so. Directly after having the band put on, it's normal to bleed a little, but you should not bleed a lot.

Another treatment for piles is to have injections around the blood vessels in your arse. This numbs the nerve endings and hardens the tissue of the piles. After about a month, the pile shrinks. Infrared light can also be used on the piles to shrink them.

If nothing else works and your piles are really painful and large, you may need surgery to remove the piles. This is usually done under a general anaesthetic and the piles are less likely to come back than with other treatment. However, it's a pretty big operation so you need a week or so for the wounds to heal.

If you have painful piles that have come out and stayed outside your arse, you may be referred for stapling. The piles are surgically stapled to the wall inside your arse which reduces their blood supply and makes them smaller. You recover faster from stapling than from surgery. There are other treatments available for piles usually only happen at private clinics which include freezing and laser treatment.

Can I have sex while having piles?
If you have piles, getting your arse fucked could be painful. Minor piles that can be pushed back in with your finger should not stop you from getting fucked but larger piles may cause you a lot of pain. Only you can know whether it's a good idea or not by touching the piles, or from the pain that they are causing. However, if you are having any surgical treatment for piles you need to wait until it has healed before having sex – otherwise it would be very painful and may interfere with the healing process. You should talk to your doctor about when you can have sex again after treatment if you are concerned.