Exercise with piles (haemorrhoids): what helps, lifting, cycling and when bleeding needs checking

Common, and often better in a few days

Piles often get better on their own after a few days. About 4 in 10 adults having a bowel check have them, most of them mild, and many people with piles have no symptoms.

Sources 1, 2, 3

Exercise helps mainly by preventing constipation

The NHS says a daily walk or run can help you poo more regularly, and suggests regular exercise to relieve constipation if you have piles in pregnancy. No trial has tested exercise as a treatment for piles.

Sources 4, 5

Soft poo and no straining matter most

In trials, extra fibre halved the chance of symptoms and bleeding carrying on, and US surgeons recommend diet and toilet habits as the first treatment. The NHS says drink lots of fluid, eat plenty of fibre, don't ignore the urge to poo and don't push too hard.

Sources 6, 7, 1

The gym: breathe out, don't bear down

The NHS lists heavy lifting among the things that make piles more likely. Breathe out on the effort, don't hold your breath and strain, and lighten heavy lifts while your piles are sore (our suggestion). The only study of sport and piles we found was a small survey.

Sources 1, 8

Keep toilet visits short

An NHS hospital advises no more than 5 minutes at a time on the toilet. In one study, people with piles were far more likely to sit there for over 20 minutes.

Sources 9, 10

Bleeding needs checking

Bright red blood after a poo is a common sign of piles, but bleeding from the bottom can also be a sign of bowel cancer. See a general practitioner (GP) about any blood in your poo, and ask for an urgent appointment or call NHS 111 for painless bleeding from your bottom.

Sources 1, 11

Swollen cushions

Everyone has soft cushions of blood vessels inside the back passage, which help keep it closed. Piles are these cushions when they swell and slip down. Internal piles are inside the back passage and are graded 1 to 4 by how far they come out; external piles are under the skin around the anus. The NHS describes them as lumps inside and around your bottom, from the size of a pea to the size of a grape.

Sources 1, 12, 13, 14

Symptoms

The NHS lists:

• 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
• lumps around your anus
• pain around your anus

Sources 1, 13, 14

Bleeding is usually painless

Bleeding from internal piles is usually painless, because the inside of the back passage has no pain-sensing nerves. Piles don't usually hurt unless a clot forms in one, most often an external pile, or one that has come out gets trapped.

Sources 13, 14, 7

How common they are

In 976 adults having a routine bowel check in Austria, 38.9% had piles, most of them mild, and fewer than half of those had symptoms. In 2,813 adults having a colonoscopy in the US, 38% had them. Piles are most common between the ages of 45 and 65.

Sources 2, 3, 14

What makes them more likely

The NHS says it's not clear what causes piles, and lists things that make them more likely: constipation, pushing too hard when pooing, heavy lifting, pregnancy, getting older and being overweight. Constipation was about twice as common in people with piles across 19 studies. Heavy lifting and hard exercise are thought to play a part by raising the pressure inside your tummy, but a review notes that these factors haven't been studied in detail. Guts UK adds that pain from piles can make people put off going to the toilet, which makes constipation worse.

Sources 1, 15, 13, 16

Treatment

Most piles settle with self-care: soft poo, no straining, short toilet visits, a warm bath, and an ice pack wrapped in a towel. A pharmacist can suggest treatments for the pain, itching and swelling, and for constipation. If they don't settle, hospital treatments include banding, injections and surgery. One NHS hospital says banding works for about 8 in 10 people, and piles are less likely to come back if you avoid constipation and straining.

Sources 1, 9

Not piles?

A small tear in the anus (an anal fissure) causes a severe, sharp pain when you poo, often with bright red blood. Bleeding from the bottom can also come from other conditions, including bowel cancer, which is why it needs checking by a GP.

Sources 17, 11

Exercise and fewer piles: a mixed pictureMixed evidence

A genetic study linked more leisure-time exercise with a slightly lower risk of piles, but only in some of its analyses, and more screen time with a slightly higher risk. In 2,813 adults having a colonoscopy, being active wasn't clearly linked with fewer piles. No trial has tested exercise as a treatment. The clearest benefit is through preventing constipation: the NHS says a daily walk or run can help you poo more regularly.

Sources 18, 3, 4

Constipation and strainingEmerging evidence

Across 19 studies, constipation was about twice as common in people with piles. In the colonoscopy study, constipation, straining and hard poo were all linked with piles. US colorectal surgeons name constipation and long, straining toilet visits among the main things to change. These are observational links, so they can't prove cause and effect.

Sources 15, 3, 7

Fibre worksStrong evidence

In a Cochrane review of 7 trials with 378 people, extra fibre roughly halved the chance of symptoms carrying on and of bleeding (moderate-quality evidence). US surgeons' and gastroenterologists' guidelines both recommend diet and toilet habit changes first, as strong recommendations based on moderate evidence. Fibre can take up to 6 weeks to work.

Sources 6, 7, 12, 14

Sport, heavy lifting and cyclingMixed evidence

The NHS lists heavy lifting as something that makes piles more likely, and a review explains why raised pressure inside the tummy might matter, while noting it hasn't been studied in detail.

The only study of sport and piles we found was a small online survey of 312 people who play sport in Italy, with piles reported by the people themselves. Bodybuilders were more likely to report piles (an odds ratio of 2.88, with a wide margin of error). Of the cyclists and horse riders, 57% reported piles, but that link wasn't significant once age, sex and other factors were taken into account, and people who went trekking or skiing reported fewer. A survey like this can't show that a sport causes piles.

Sources 1, 13, 8

Long toilet visits and phonesMixed evidence

In 125 adults having a bowel check, people who used their phone on the toilet were more likely to sit there for over 5 minutes, and had 46% higher odds of piles. In a Turkish study, people with piles were far more likely than people without to sit on the toilet for over 20 minutes (12.5% against 0.5%), but they used phones on the toilet less, probably because they'd changed their habits after their symptoms began. US gastroenterologists advise against long spells on the toilet, including reading or using a phone.

Sources 19, 10, 12

Sitting at a deskMixed evidence

In the colonoscopy study, the people who sat most during the day had slightly fewer piles, not more. The NHS still suggests avoiding standing or sitting for long periods if you have piles in pregnancy. Long spells on the toilet, rather than ordinary sitting, are the habit with evidence against them.

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PregnancyEmerging evidence

In a trial in 260 pregnant women in Lithuania, advice on daily walking or exercise for 30 to 60 minutes 3 to 5 times a week, at least 1.5 litres of fluid, more fibre, and toilet visits under 3 minutes cut piles by the time women left hospital after the birth from 40.8% to 15.4%. Exercise was one part of the package, so its own effect can't be separated, and more women dropped out of the advice group.

In a study of 280 pregnant women, 40.7% developed piles, mostly late in pregnancy or after the birth, and constipation was one of the strongest links. In another, women who weren't active enough were more likely to be constipated.

Sources 20, 21, 22

Walking and other moderate activity

Aim to build towards the NHS guideline of 150 minutes of moderate activity a week, such as 30 minutes of brisk walking on 5 days. A daily walk or run can help you poo more regularly. In the pregnancy trial, women were advised to walk or exercise for 30 to 60 minutes, 3 to 5 times a week.

Sources 23, 4, 20

Strength, without straining

The NHS guideline adds strength exercises on 2 days a week. Choose weights you can lift while breathing steadily, breathe out on the effort, and don't hold your breath and bear down (our suggestion, given that the NHS lists heavy lifting as a risk). While your piles are sore or bleeding, use lighter weights, machines or bands for a while.

Sources 23, 1

Fibre and fluids

The NHS says drink lots of fluid and eat plenty of fibre to keep your poo soft, and cut down on alcohol and caffeine. US gastroenterologists suggest 20 to 30 g of fibre and 6 to 8 glasses of fluid a day. Build fibre up gradually; our constipation guide and water intake calculator give the amounts.

Sources 1, 12

Timing

The urge to poo often comes after a meal and in the morning: the pregnancy trial suggested trying 30 to 40 minutes after eating, and in the morning. A walk after breakfast fits well (our suggestion).

Source 20

What the NHS says

The NHS websites for England and Scotland (NHS inform) both list heavy lifting among the things that make piles more likely, alongside constipation and pushing too hard when you poo.

Sources 1, 24

How to lift with piles

The concern is pressure: holding your breath and bearing down raises the pressure inside your tummy, which may slow blood flow out of the cushions. So breathe out on the effort, choose weights you can lift without straining, and avoid grinding out the last rep (our suggestion). While your piles are sore, lighten heavy deadlifts, squats, the leg press and kettlebell swings, or swap them for machines and bands, then build back up as they settle.

Source 13

Cycling

We found no study testing cycling for piles. In the one survey of people who play sport, the link with cycling and horse riding wasn't significant once age, sex and other factors were taken into account. Saddle studies in male cyclists found that no-nose saddles and recumbent bikes lowered the pressure between the legs, though no-nose saddles shift pressure backwards and feel less stable.

If riding is sore, shorten your rides, stand up on the pedals regularly, check your saddle set-up with our cycling guide, and walk or swim for a while (our suggestion).

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Running

The NHS mentions a daily walk or run for keeping your bowels regular. If running makes your piles sore, walk or swim instead until they settle (our suggestion).

Source 4

Letting go on the toilet

People with piles tend to have higher pressure in the muscles around the anus. Learning to let your pelvic floor and bottom relax on the toilet helps you empty without straining, and the pelvic floor relaxation move shows how.

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Squeezes are for leaking

We found no trial of pelvic floor exercises (Kegels) for piles. Do them if you also leak. If emptying is hard, or you feel you can't let go, see a GP or a pelvic health physiotherapist rather than adding more squeezes. Our pelvic floor guide covers both.

Common in pregnancy

In one study, 40.7% of 280 pregnant women developed piles, mostly late in pregnancy or after the birth; in another, 68% of 94 women had symptoms around the bottom. Constipation was the common thread.

Sources 21, 26, 5

What the NHS suggests

For piles in pregnancy, the NHS suggests:

• eating plenty of fibre, such as wholemeal bread, fruit and vegetables, and drinking plenty of water
• avoiding standing or sitting for long periods
• taking regular exercise to help relieve constipation
• avoiding straining when you poo
• holding a cloth wrung out in iced water gently against the piles to ease pain
• checking with your doctor, midwife or pharmacist before using any cream

Source 5

Exercise in pregnancy

In the Lithuanian trial, daily walking or exercise was part of the advice that cut piles after the birth. Follow the usual pregnancy guidance: stop if you feel uncomfortable, too hot or unwell, and from later in pregnancy, keep exercises on your back short, as our pregnancy guide explains.

Sources 20, 27

After the birth

The NHS advises avoiding straining on the toilet and heavy lifting at first after the birth. In one study, pushing for more than 20 minutes in labour and a baby over 3,800 g were linked with piles. Our postpartum guide covers getting back to exercise.

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After banding

North Bristol NHS Trust says most people are back to their normal routine within 1 to 2 days, and advises drinking at least 2 litres a day and not straining or sitting on the toilet for more than 5 minutes. Bleeding can increase 7 to 10 days afterwards. Another hospital's older leaflet suggests avoiding sport, cycling and running for a few days.

Sources 9, 29

After surgery

One hospital's older leaflet says no exercise or work for 1 to 2 weeks after piles surgery, and another stresses avoiding straining. Follow the leaflet your own hospital gives you.

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Go to A&E or call 999

The NHS says go to accident and emergency (A&E) or call 999, and don't drive yourself, if you have piles and:

• you're bleeding non-stop
• there's a lot of blood, or you see large blood clots
• you're in severe pain

Sources 1, 32

Ask for an urgent GP appointment or call NHS 111

• your temperature is very high, or you feel hot, cold or shivery and generally unwell
• painless bleeding from your bottom
• pus leaking from your piles
• your poo is black or dark red, or you have bloody diarrhoea

Sources 1, 32

See a GP

• your piles are getting worse, or not improving with treatment at home
• you keep getting piles
• you notice a change around your anus that isn't normal for you
• you have any blood in your poo, or a change in your poo that isn't usual for you
• you've lost weight without trying, or have tummy pain or a lump in your tummy

Sources 1, 32, 24

Why bleeding is checked

Bleeding from the bottom is sometimes a sign of bowel cancer, and US colorectal surgeons warn that bleeding put down to piles is a common way it gets missed. A GP may examine your bottom or arrange tests, which is routine. The NHS says try not to be embarrassed: doctors are used to talking about this.

Sources 11, 7, 32

Sharp pain when you poo

A severe, sharp pain when you poo, with bright red blood, may be an anal fissure. See a GP if it isn't getting better after 7 days.

Source 17

If exercise brings on symptoms

If a session brings on pain, a lump that won't go back in, or bleeding, stop, swap to gentler exercise for a while, and see a GP if it keeps happening (our suggestion).

"Lifting weights causes piles"Mixed evidence

The NHS lists heavy lifting among the things that make piles more likely, but it hasn't been studied in detail, and one small survey linked bodybuilding with more piles. Constipation and straining have much better evidence. How you lift probably matters: breathe out rather than bearing down.

Sources 1, 13, 8, 15

"Cycling causes piles"Mixed evidence

We found no study testing it, and in one survey the link wasn't clear once age, sex and other factors were allowed for. A sore bottom on the saddle is a reason to shorten rides for a while, not proof of harm.

Source 8

"Sitting down a lot causes piles"Mixed evidence

In a study of 2,813 adults, those who sat most had slightly fewer piles. Long spells on the toilet are a different matter: they're linked with piles.

Sources 3, 19, 10

"Kegels or yoga poses shrink piles"Emerging evidence

We found no trial of pelvic floor exercises or yoga for piles. People with piles tend to have tighter muscles around the anus, so learning to relax them on the toilet may matter more.

Source 15

"With piles, you should stop exercising"Strong evidence

The NHS suggests regular exercise to help with constipation, including with piles in pregnancy, and in a trial, a package that included daily walking cut piles in pregnancy.

Sources 5, 4, 20

"Bleeding from the bottom is always piles"Strong evidence

Bright red blood is common with piles, but bleeding from the bottom can be a sign of bowel cancer, and bleeding put down to piles is a common way it gets missed. See a GP about any blood in your poo.

Sources 11, 7

"Push harder to get it over with"Strong evidence

The NHS says don't push too hard when you poo, and don't spend longer on the toilet than you need to. Straining can make piles worse.

Sources 1, 5