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
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
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
Piles Treatment & Surgery FAQs
Piles Treatment & Surgery FAQs
How Can I Prevent Varicose Veins?
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.
How do I prepare for my vascular ultrasound?
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.
