Haemorrhoids, Piles

Overview

Haemorrhoids, also known as piles, are swollen veins in the anus and lower rectum. It is a very common condition and frequently occurs without any apparent cause or symptom. Some might not even be aware that they have piles. Haemorrhoids can develop from inside (internal haemorrhoids) or outside (external haemorrhoids) of the anus.

Symptoms

  • Bleeding after passing out stools
  • Swelling around the anus
  • Pain or itch around the anus
Spider Vein Treatment Procedure

When to Seek Treatment

  • Bleeding during or after bowel movements
  • Pain, swelling or itch around the anus

If there are symptoms as described above, proper assessment should be made. Early diagnosis will help to prevent worsening, and also rule out other more serious problems like colorectal cancer. It is not possible to distinguish between the two unless special tests are performed.

Diagnosis

Physical examination will determine the presence and severity of haemorrhoids. Haemorrhoids can be classified into four grades.

Treatment

There are many treatment methods for piles. The type of treatment chosen depends on the severity of the disease. Common methods include medication, dietary modification, local treatment such as rubber-band ligation or HET, and surgery. Your doctor will advise which method is the most suitable.

Early Stages

Dietary modification and/or medication may be enough.

Some may think that piles will go away by avoiding spicy or fried foods. These are myths without strong scientific evidence. However, lifestyle modifications may be helpful, such as

  • Exercising regularly
  • Increasing fibre intake (e.g. fruits and vegetables)
  • Drinking plenty of water so as to avoid constipation

Smaller Piles

Local treatment options such as rubber-band ligation or HET may be needed.

Later Stages

Surgery may be required to treat the piles. Especially so if the haemorrhoids prolapse out of the anus and cannot be pushed back in. Types of surgical treatment include conventional haemorrhoidectomy, stapler haemorrhoidectomy and transanal haemorrhoidal dearterialization (THD).

Conventional or Open Haemorrhoidectomy

  • The piles are excised, or cut off.
  • This can be performed using different types of instruments.
  • Care is taken to make sure that there is no bleeding, and that not too much tissue is removed.
  • The wound is usually left open to heal.

Stapler Haemorrhoidectomy

  • A special stapler is used to remove tissue in the rectum, pull the haemorrhoids back into the anus, and reduce the blood supply to the haemorrhoids
  • After blood supply to the haemorrhoids is reduced, the haemorrhoids will gradually shrink in size.
  • The surgical wound is within the rectum, and there is no external wound, unless anal skintags are removed at the same sitting.

Transanal Haemorrhoidal Dearterialization (THD)

  • In THD, a special instrument is inserted in the anus.
  • Using an ultrasound probe, the location of blood vessels supplying the haemorrhoids is identified, and these blood vessels are tied off.
  • If there is excessive tissue, these tissues can be stitched together, thus pulling the haemorrhoids back into the anal canal.

Causes

  • Constipation
  • Straining during bowel movement
  • Prolonged duration of bowel movement.

Risk Factors

Pregnancy predisposes to piles. This is due to the womb pressing on the large blood vessels in the back, causing back pressure on the veins, leading to piles.

Consult Our Doctor

Dr Jane Tan Jye Yng
Colorectal & General Surgeon

MBBS (Singapore), M.Med (Surgery), MRCS (Edin), FAMS (Surgery)

Piles Treatment & Surgery FAQs

Not all patients with piles require surgery. In the early stages, medication or local treatment methods such as ligation can be effective.
Surgery for piles is considered minor, with low risks. Most patients do not need an overnight stay, and the procedure can be performed as a day surgery.
When the piles cannot be successfully treated with medication or local treatment methods (eg ligation), or if there are complications such as bleeding, prolapse or thrombosis.
In conventional (traditional) surgery for piles, post-operative wound pain is considerable, particularly during and after a bowel movement. Surgical methods such as stapler haemorrhoidectomy or haemorrhoidal artery ligation are advantageous in that post-operative pain is much less compared to traditional piles surgery.
Unfortunately, piles do have a tendency to recur.
There are many different types of surgery for piles. The choice of surgery depends on the severity of the disease.

Piles Treatment & Surgery FAQs

Avoiding standing still for long periods will reduce the pressure in the veins in the legs. For people who need to stand for long periods at work, wearing compression stockings will reduce the pressure build up in the legs.

The ultrasound will be done of the legs from the thigh to the calves. Please wear or bring along a pair of shorts to change into for the scan.

Have a question or need a second opinion?