Non-Bleeding Piles/Internal Haemorrhoids (Shushka Arsha)


Non-bleeding piles, also known as internal hemorrhoids, are a common condition characterized by swollen blood vessels in the rectal area. This article provides a comprehensive overview of non-bleeding piles, including their epidemiology, types, underlying mechanisms, risk factors, signs and symptoms, diagnostic methods, treatment options, and preventive measures.


Non-bleeding piles are a form of hemorrhoids that occur inside the rectum and do not typically cause bleeding. They can be a source of discomfort and pain, affecting the quality of life for individuals. Understanding the causes, symptoms, and effective management of non-bleeding piles is essential for promoting rectal health and well-being.

Epidemiology of Non-Bleeding Piles:

Non-bleeding piles are a common condition, with a prevalence that increases with age. While they may not cause bleeding, they can lead to discomfort and other symptoms.

Types of Non-Bleeding Piles:

Non-bleeding piles can be categorized into different degrees based on their severity:

  1. First-Degree Hemorrhoids:

    • These are the mildest form of internal hemorrhoids.
    • They are located within the rectum and do not prolapse (bulge) outside the anus.
    • Typically, they do not cause significant discomfort or pain.
  2. Second-Degree Hemorrhoids:

    • Second-degree hemorrhoids may prolapse (bulge) outside the anus during bowel movements.
    • However, they usually retract (go back inside) on their own after the bowel movement is complete.
    • They may cause discomfort, pain, itching, or a feeling of fullness.
  3. Third-Degree Hemorrhoids:

    • Third-degree hemorrhoids prolapse outside the anus during bowel movements and need manual reinsertion.
    • They may cause more significant discomfort, pain, and irritation.
    • In some cases, they can become trapped outside the anus, leading to a condition called incarcerated hemorrhoids.
  4. Fourth-Degree Hemorrhoids:

    • Fourth-degree hemorrhoids are permanently prolapsed and cannot be manually reinserted into the anus.
    • They may cause chronic pain, irritation, bleeding, and difficulty with hygiene.
    • Complications such as blood clots (thrombosis) can occur in these hemorrhoids.

Pathophysiology of Non-Bleeding Piles:

Non-bleeding piles occur due to the swelling of blood vessels within the rectal area. This can be caused by increased pressure on the rectum during bowel movements, straining, or prolonged sitting.

Risk Factors and Triggers:

Several factors can increase the risk of developing non-bleeding piles:

  1. Age:

    • The risk of developing internal haemorrhoids increases with age, especially among individuals over 50.
  2. Genetics:

    • A family history of haemorrhoids can increase the likelihood of developing the condition.
  3. Pregnancy:

    • The pressure of the growing uterus on the veins in the pelvic area during pregnancy can contribute to the development of haemorrhoids.
  4. Chronic Constipation:

    • Straining during bowel movements due to chronic constipation can put pressure on the veins in the rectum and contribute to haemorrhoids.
  5. Chronic Diarrhoea:

    • Chronic diarrhoea can irritate the rectal area and increase the risk of haemorrhoid development.
  6. Obesity:

    • Excess body weight can contribute to increased pressure on the veins in the pelvic and rectal areas.
  7. Sedentary Lifestyle:

    • Lack of physical activity and prolonged sitting can lead to poor circulation in the pelvic region and contribute to haemorrhoids.
  8. Heavy Lifting:

    • Regularly lifting heavy objects can strain the abdominal muscles and increase pressure on the veins in the rectal area.
  9. Low-Fibre Diet:

    • Diets low in fibre can lead to constipation, which in turn increases the risk of haemorrhoids.

Triggers for Non-Bleeding Piles:

  1. Straining During Bowel Movements:

    • Straining due to constipation or hard stools can put pressure on the veins in the rectal area and lead to haemorrhoids.
  2. Prolonged Sitting:

    • Sitting for extended periods, especially on hard surfaces, can impede blood flow and contribute to haemorrhoid development.
  3. Inadequate Hydration:

    • Insufficient fluid intake can lead to hard stools and constipation, increasing the risk of haemorrhoids.
  4. Chronic Coughing or Sneezing:

    • Frequent coughing or sneezing can increase intra-abdominal pressure and contribute to haemorrhoid formation.
  5. Uncontrolled Diabetes:

    • Poorly controlled diabetes can affect blood vessels and contribute to circulatory problems that increase the risk of haemorrhoids.

Sign & Symptoms of Non-Bleeding Piles:

Non-bleeding piles present with various symptoms:

  1. Discomfort and Itching:

    • Many individuals with internal haemorrhoids experience discomfort, itching, or a burning sensation in the anal or rectal area.
  2. Prolapse During Bowel Movements:

    • Second-degree internal haemorrhoids may prolapse (bulge) outside the anus during bowel movements and retract back on their own afterward.
  3. Feeling of Incomplete Bowel Movement:

    • Prolapsed haemorrhoids or the presence of internal haemorrhoids can give a sensation of not having fully emptied the bowels after a bowel movement.
  4. Pain and Discomfort:

    • Third-degree haemorrhoids may prolapse and require manual reinsertion, causing pain and discomfort.
  5. Swelling and Inflammation:

    • Internal haemorrhoids can become swollen, causing localized inflammation and discomfort.
  6. Mucus Discharge:

    • Some individuals may notice mucus discharge from the anus, which can be associated with internal haemorrhoids.
  7. Difficulty Cleaning After Bowel Movements:

    • Swollen internal haemorrhoids can make cleaning the anal area after bowel movements challenging and uncomfortable.
  8. Thrombosis (Blood Clot):

    • In some cases, internal haemorrhoids can become thrombosed (develop blood clots), causing severe pain, swelling, and a bluish appearance.
  9. Minor Rectal Bleeding (Sometimes):

    • While non-bleeding piles typically don’t cause visible blood in the stool, small amounts of bright red blood on toilet tissue or in the toilet bowl may occasionally occur.
  10. Discomfort While Sitting:

    • Sitting for prolonged periods can exacerbate discomfort and pain in individuals with internal haemorrhoids.

Investigation & Diagnosis of Non-Bleeding Piles:

Diagnosing non-bleeding piles involves:

  1. Visual Inspection:

    • The healthcare provider may use a proctoscope, anoscope, or sigmoidoscope—a thin, flexible tube with a light and camera—to visually inspect the inside of the rectum and lower colon.
  2. Internal Examination:

    • Internal hemorrhoids can be examined during the visual inspection to determine their size, location, and degree of prolapse.
  3. Medical Imaging (if needed):

    • In some cases, medical imaging such as an endoscopy or sigmoidoscopy may be recommended to further evaluate the rectal and anal areas.
  4. Colonoscopy (if indicated):

    • A colonoscopy may be performed if there is a need to examine the entire colon and rule out other colorectal conditions.

Treatment of Non-Bleeding Piles in Modern Medical Science:

Treatment aims to relieve symptoms and reduce inflammation:

  1. Lifestyle Modifications:

    • Increasing dietary fibre intake to prevent constipation and promote regular bowel movements.
    • Drinking plenty of water to stay hydrated and soften stools.
    • Avoiding straining during bowel movements and using the bathroom as needed.
    • Engaging in regular physical activity to improve circulation and bowel function.
  2. Topical Medications:

    • Over-the-counter or prescription creams, ointments, or suppositories containing hydrocortisone, lidocaine, or other ingredients can provide relief from pain and itching.
  3. Sitz Baths:

    • Sitting in warm water (sitz bath) for 15-20 minutes a few times a day can help alleviate discomfort and promote healing.
  4. Oral Pain Relievers:

    • Over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil) can help manage pain and inflammation.
  5. Minimally Invasive Procedures:

    • Rubber Band Ligation: A small rubber band is placed around the base of the haemorrhoid to cut off its blood supply, causing it to shrink and fall off.
    • Infrared Coagulation: A heat source is used to coagulate the blood vessels supplying the haemorrhoid, leading to its shrinking.
    • Sclerotherapy: A chemical solution is injected into the haemorrhoid to shrink it by reducing blood flow.
  6. Haemorrhoidal Artery Ligation (HAL):

    • A procedure that involves tying off the blood vessels supplying the haemorrhoid using a special device, causing it to shrink.
  7. Haemorrhoidectomy:

    • Surgical removal of the haemorrhoid tissue may be recommended for severe or persistent cases that do not respond to other treatments.

Prevention & Precaution for Non-Bleeding Piles:

Preventive measures include:

  1. High-Fibre Diet:

    • Include plenty of fibre-rich foods such as whole grains, fruits, vegetables, legumes, and nuts in your diet to promote regular bowel movements and prevent constipation.
  2. Adequate Hydration:

    • Drink plenty of water throughout the day to keep stools soft and prevent straining during bowel movements.
  3. Regular Physical Activity:

    • Engage in regular exercise to improve circulation, promote bowel regularity, and maintain a healthy weight.
  4. Avoid Straining:

    • Avoid straining during bowel movements. Take your time and avoid rushing.
  5. Timely Bowel Movements:

    • Respond promptly to the urge to have a bowel movement to prevent stool from becoming hard and difficult to pass.
  6. Avoid Prolonged Sitting:

    • Avoid sitting for extended periods, especially on hard surfaces. Take breaks and stand or walk periodically.
  7. Hygiene After Bowel Movements:

    • Clean the anal area gently with moistened toilet paper or a gentle wipe to prevent irritation.
  8. Sitz Baths:

    • Take warm sitz baths (sitting in warm water) for 15-20 minutes after bowel movements to soothe the anal area.
  9. Avoid Spicy and Irritating Foods:

    • Limit or avoid consuming spicy, acidic, and hot foods that can irritate the digestive tract.
  10. Avoid Heavy Lifting:

    • Avoid heavy lifting, especially if it involves straining, as it can increase intra-abdominal pressure.
  11. Manage Chronic Cough:

    • If you have a chronic cough, seek medical treatment to prevent excessive strain on the pelvic area.
  12. Manage Chronic Diarrhoea:

    • If you experience chronic diarrhea, seek medical guidance to prevent irritation and straining.
  13. Avoid Alcohol and Tobacco:

    • Limit alcohol consumption and avoid tobacco use, as these can contribute to constipation and other digestive issues.

Ayurvedic Perspective on Non-Bleeding Piles:

In Ayurveda, non-bleeding piles are often referred to as “Arsha.” This condition is believed to result from an imbalance of the Vata dosha, leading to congestion and inflammation of the blood vessels in the rectal area. Ayurveda emphasizes the importance of maintaining proper digestion (Agni), managing Vata imbalance, and adopting a balanced lifestyle to prevent and manage non-bleeding piles.

Ayurvedic Treatment Principles for Non-Bleeding Piles:

Ayurvedic treatments for non-bleeding piles focus on alleviating Vata imbalance, reducing inflammation, and promoting regular bowel movements. Some treatment principles include:

  1. Dietary Recommendations:

    • Opt for a diet rich in fiber from whole grains, fruits, and vegetables to promote regular bowel movements and prevent constipation.
    • Avoid spicy, fried, and hot foods that can aggravate Pitta dosha.
  2. Herbal Remedies:

    • Triphala: A blend of three fruits (amla, haritaki, bibhitaki), triphala helps regulate bowel movements and supports digestion.
    • Haritaki (Terminalia chebula): This herb is known for its laxative and digestive properties, promoting healthy bowel movements.
    • Vidanga (Embelia ribes): It is used to address digestive issues and promote proper elimination.
  3. Herbal Enemas:

    • Basti (enema) therapy with herbal oils or decoctions can help cleanse the colon and promote healthy bowel function.
  4. Ghee (Clarified Butter) Therapy:

    • Consuming a small amount of medicated ghee (ghrita) each day can help lubricate the digestive tract and ease bowel movements.
  5. Sitz Baths:

    • Taking warm sitz baths with herbal decoctions like triphala or neem can soothe the anal area and promote healing.
  6. Lifestyle Recommendations:

    • Avoid suppressing the urge to have a bowel movement.
    • Engage in gentle physical activity and yoga to improve digestion and circulation.
    • Practice stress reduction techniques to prevent Vata imbalance.

Ayurvedic Lifestyle Recommendations for Non-Bleeding Piles:

Ayurveda suggests lifestyle practices to manage and prevent non-bleeding piles:

  1. Hydration: Drinking warm water throughout the day to maintain hydration and support digestion.
  2. Physical Activity: Engaging in regular exercise to improve bowel function and prevent stagnation.
  3. Avoid Straining: Practicing gentle and relaxed bowel movements to prevent excessive pressure on the rectal area.

The Role of Ayurveda in Non-Bleeding Piles Prevention:

Ayurveda plays a crucial role in preventing non-bleeding piles by promoting balanced digestion, reducing Vata imbalance, and advocating a lifestyle that supports healthy bowel movements. Following Ayurvedic guidelines can help prevent the recurrence of non-bleeding piles.

Ayurvedic Researches on Non-Bleeding Piles:

While Ayurvedic texts discuss herbal remedies and lifestyle practices for digestive health, scientific research on Ayurvedic treatments for non-bleeding piles is limited. More studies are needed to explore the effectiveness of Ayurvedic interventions.

Challenges and Future Directions:

Integrating Ayurveda into mainstream healthcare for non-bleeding piles management requires addressing challenges such as evidence-based research, standardization of treatments, and collaboration between traditional and modern medical systems. Future research can contribute to a deeper understanding of Ayurveda’s potential in promoting digestive and rectal health.


Ayurveda offers a holistic approach to managing non-bleeding piles by addressing Vata imbalance, improving digestion, and promoting regular bowel movements. While further research is necessary, Ayurvedic principles, herbal remedies, and lifestyle adjustments can complement modern medical approaches and contribute to healthier digestive and rectal function.

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