Buasir (piles, or haemorrhoids) are swollen blood vessels inside or around the bottom that can cause bright red bleeding after a bowel movement, itching, pain and lumps around the anus. They are very common and, according to the NHS, often get better on their own within a few days. Constipation and straining are among the main things that make piles more likely, so keeping your poo soft with fibre and fluids is the most important step: a meta-analysis found fibre roughly halved the risk of persistent symptoms and bleeding. A pharmacist can recommend creams and other treatments, and larger piles can be treated in hospital. Because bleeding from the bottom can also have more serious causes, it should always be checked by a doctor. This guide explains the symptoms, grades (tahap), causes, home treatment, pharmacy options, hospital treatment and warning signs.
What is buasir?
Buasir is the Malay word for piles, also known as haemorrhoids (hemorrhoids in American English). Everyone has cushions of blood vessels in the anal canal; piles are when these become swollen and cause symptoms. They are usually described by where they form:
- Internal piles (buasir dalam) form inside the back passage, above a line called the dentate line. They are often painless but can bleed or come out (prolapse).
- External piles (buasir luar) form under the skin around the anus. They can be itchy or sore, and very painful if a blood clot forms inside them.
- Mixed piles involve both areas.
What are the symptoms of piles?
According to the NHS, symptoms of piles (tanda buasir) include:
- bright red blood after you poo;
- an itchy anus;
- feeling like you still need to poo after going to the toilet;
- mucus in your underwear or on toilet paper after wiping;
- lumps around your anus;
- pain around your anus.
What do piles look like (rupa buasir)? The NHS describes them as small lumps, around the size of a pea, that can be pink or purple, and can grow into larger lumps the size of grapes.
Buasir tahap 1 to 4: the grades of piles
Doctors grade internal piles by how far they come out, using the Goligher classification:
Lower-grade piles usually respond to home treatment and pharmacy products. Higher-grade piles, or piles that keep coming back, are more likely to need treatment in hospital.
What causes piles?
The NHS says it is not clear exactly what causes piles, but these make them more likely (punca buasir):
- constipation;
- pushing too hard when pooing;
- heavy lifting;
- pregnancy;
- getting older;
- being overweight.
Because constipation and straining are so closely linked to piles, our guide to sembelit (constipation) is a good place to start.
How to treat piles at home
These steps, recommended by the NHS, can ease symptoms and help piles settle (cara merawat buasir):
- drink plenty of fluids and eat plenty of fibre to keep your poo soft;
- gently push a pile back inside if you can;
- use an ice pack wrapped in a towel to ease discomfort;
- take a warm bath to ease itching and pain;
- keep your bottom clean and dry, and pat rather than rub it dry;
- take paracetamol if piles hurt;
- cut down on alcohol and caffeine (tea, coffee, cola) to avoid constipation.
Avoid: ignoring the urge to poo, pushing too hard, spending longer than needed on the toilet, painkillers containing codeine (which can cause constipation), and ibuprofen if your piles are bleeding.
Fibre really helps. A meta-analysis of seven trials found that people taking fibre had a 47% lower risk of persistent symptoms and a 50% lower risk of bleeding compared with those who did not. Wholegrains, vegetables, fruit, beans and lentils are good sources; increase fibre gradually and drink water as you do.
How long until piles shrink (berapa lama buasir akan kecut)? The NHS says piles often get better on their own after a few days. See a doctor if they are getting worse or not improving with home treatment.
Ubat buasir: what the pharmacy can offer
A pharmacist can suggest:
- creams or ointments to ease pain, itching and swelling;
- laxatives or fibre supplements to soften your poo and treat constipation;
- cold packs to ease discomfort.
Some pharmacies also sell flavonoid (phlebotonic) tablets for piles. A Cochrane review of 20 trials found that phlebotonics improved bleeding, itching, discharge and overall symptoms compared with control treatments, but the authors noted methodological limitations and called for better trials. Ask your pharmacist whether they suit you.
Be cautious with "ubat buasir tradisional" and products sold online that promise to shrink piles overnight. They may not be registered or may contain undeclared ingredients; our guide to checking KKM registration shows how to check a product. Always tell the pharmacist if you are pregnant, breastfeeding or take other medicines.
Hospital treatment for piles
If home treatment does not work, the NHS describes these options (rawatan buasir):
- Without surgery (you stay awake, usually go home the same day): rubber band ligation, where a band makes the pile drop off; sclerotherapy, an injection that shrinks it; electrotherapy; and infrared coagulation.
- Surgery (usually under general anaesthetic): haemorrhoidectomy to cut the piles out, stapled haemorrhoidopexy, or haemorrhoidal artery ligation to cut off their blood supply.
Treatment does not always stop piles from coming back, so keeping your poo soft remains important afterwards.
Piles in pregnancy
Piles are common during pregnancy, often because of constipation. The NHS suggests eating plenty of fibre (wholemeal bread, fruit and vegetables), drinking water, exercising regularly, avoiding standing or sitting for long periods, not straining, using a cloth wrung out in iced water to ease pain, and cleaning with moist rather than dry toilet paper. Check with your doctor, midwife or pharmacist before using any cream or medicine during pregnancy.
When to see a doctor
Bleeding from the bottom is common with piles, but it can also be a sign of other conditions, including bowel cancer. The NHS lists these as possible bowel cancer symptoms: changes in your poo that are not usual for you, blood in your poo that looks red or black, bleeding from your bottom, often feeling you need to poo, tummy pain or a lump, bloating, weight loss without trying, and tiredness or breathlessness from anaemia. If bleeding leaves you tired or breathless, see our guide to kurang darah (anaemia).
See a doctor if:
- your symptoms are getting worse or not improving with home treatment;
- you keep getting piles;
- you notice a change around your anus that is not normal for you;
- you have any symptoms of bowel cancer listed above.
Get an urgent appointment if you have piles and a very high temperature or feel hot, shivery and unwell, painless bleeding from the bottom, pus leaking from the piles, black or dark red poo, or bloody diarrhoea.
Call 999 or go to the emergency department if you are bleeding non-stop, there is a lot of blood or large blood clots, or you are in severe pain.
Frequently asked questions (FAQ)
What is buasir in English?
Buasir is the Malay word for piles, also called haemorrhoids (hemorrhoids): swollen blood vessels inside or around the bottom (anus). Internal piles form inside the back passage, while external piles form under the skin around the anus.
How long does it take for piles to shrink (berapa lama buasir akan kecut)?
According to the NHS, piles often get better on their own after a few days. Keeping your poo soft with fibre and fluids, not straining, and using a cold pack or warm bath can help. See a doctor if they get worse, keep coming back, or do not improve with home treatment.
What is the best ubat buasir at the pharmacy?
A pharmacist can suggest creams to ease pain, itching and swelling, and laxatives or fibre to soften your poo. Some pharmacies also sell flavonoid (phlebotonic) tablets; a Cochrane review found they may reduce bleeding and itching, although the studies had limitations. Tell the pharmacist if you are pregnant or take other medicines.
Is bleeding from piles (buasir berdarah) dangerous?
Piles commonly cause bright red blood after you poo. But bleeding from the bottom can also be caused by other conditions, including bowel cancer, so see a doctor to get it checked, especially if you also have a change in bowel habits, weight loss, tummy pain or tiredness. Call 999 if you are bleeding non-stop or passing large clots.
What is buasir tahap 4 (grade 4 piles)?
Internal piles are graded 1 to 4. Grade 1 piles bleed but do not come out; grade 2 come out when you strain and go back by themselves; grade 3 come out and need to be pushed back; grade 4 stay outside all the time and cannot be pushed back. Grade 3 and 4 piles often need hospital treatment.
What causes piles (punca buasir)?
It is not clear exactly what causes piles, but they are more likely with constipation, pushing too hard when pooing, heavy lifting, pregnancy, getting older and being overweight.
Can I get piles during pregnancy?
Yes, piles are common in pregnancy, often because of constipation. Eating plenty of fibre, drinking water, exercising, avoiding straining and not standing or sitting for long periods can help. Check with your doctor, midwife or pharmacist before using any cream or medicine.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor or pharmacist. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Piles (haemorrhoids) — NHS
- Piles in pregnancy — NHS
- Symptoms of bowel cancer — NHS
- Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012;18(17):2009-2017.
- Alonso-Coello P, et al. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101(1):181-188.
- Perera N, et al. Phlebotonics for haemorrhoids. Cochrane Database Syst Rev. 2012;(8):CD004322.
