Swellings that develop from below the anal cushions are sometimes called external piles. They can be more painful than the other types of piles. Other causes of lumps around the anus can include a “sentinel pile”, which is the painless skin tag that develops when a crack in the anus (an anal fissure) heals up. Also, a collection of blood under the skin, called a peri-anal haematoma, may also be referred to as a type of external pile. The treatment of these conditions is different from true piles.