Hemorrhoid/Piles Surgery

What are haemorrhoids? 

Haemorrhoids, also known as piles, are swollen and inflamed veins located in the lower part of the rectum or anus. They are similar to varicose veins and can develop either internally, inside the rectum, or externally, under the skin around the anus. While everyone has haemorrhoidal tissue that helps with stool control, the term “haemorrhoids” typically refers to a pathological condition in which these veins become enlarged or symptomatic.

Types of haemorrhoids

There are two main types of haemorrhoids:

• Internal haemorrhoids — these occur inside the rectum and are usually painless but may cause painless rectal bleeding, often noticed as bright red blood on toilet paper or in the toilet bowl.

• External haemorrhoids — these form under the skin around the anus and can cause significant pain, swelling, itching, and discomfort. If a blood clot forms inside an external haemorrhoid (thrombosis), it can become especially painful and appear as a hard lump near the anal opening.

Haemorrhoids are extremely common and affect both men and women, particularly between the ages of 45 and 65. They can result from increased pressure in the lower rectum due to straining during bowel movements, chronic constipation or diarrhoea, pregnancy, obesity, or prolonged sitting. Although not usually dangerous, haemorrhoids can significantly impact quality of life and often require medical evaluation if symptoms persist or worsen.

With timely treatment and proper lifestyle changes, most people experience relief from symptoms and can prevent recurrence.

What causes haemorrhoids? 

Haemorrhoids develop when the veins in the lower rectum or anus become stretched and swollen due to increased pressure. This pressure affects blood flow and weakens the supporting tissues of the anal canal, leading to enlargement of the haemorrhoidal cushions.

Common causes include:

• Straining during bowel movements — a major contributor, often linked to chronic constipation or hard stools.

• Prolonged sitting on the toilet — this increases pressure in the rectal veins, especially during extended toilet time.

• Chronic diarrhoea or constipation — both conditions cause repeated irritation and pressure on the rectal veins.

• Pregnancy — the weight of the uterus and hormonal changes can increase pressure on the pelvic veins, making haemorrhoids more likely.

• Obesity — excess body weight, especially around the abdomen, raises intra-abdominal pressure and compresses rectal veins.

• Heavy lifting or strenuous activity — repeated heavy lifting can contribute to haemorrhoid formation by increasing intra-abdominal pressure.

• Ageing — tissues in the rectal area naturally weaken with age, which makes haemorrhoids more common in older adults.

While many of these causes are linked to lifestyle, the good news is that most are also modifiable. Improving bowel habits, staying active, and maintaining a healthy weight can significantly reduce the risk of developing haemorrhoids.

What are the symptoms of haemorrhoids? 

The symptoms of haemorrhoids depend on their type—internal or external—but they often cause irritation, discomfort, and bleeding in the anal region. Some people may experience only mild symptoms, while others may have more persistent or painful issues that interfere with daily life.

Typical symptoms include:

• Painless rectal bleeding — bright red blood may appear on toilet paper, in the toilet bowl, or on the surface of the stool. This is common with internal haemorrhoids.

• Itching or irritation around the anus — caused by mucus discharge or inflamed skin, often due to external haemorrhoids.

• Pain or discomfort — especially during bowel movements or when sitting, usually linked to external or thrombosed haemorrhoids.

• Swelling or a lump near the anus — this may be a prolapsed internal haemorrhoid or a thrombosed external haemorrhoid that feels like a hard, tender lump.

• Mucus discharge — prolapsed haemorrhoids may leak mucus, causing irritation or a feeling of incomplete bowel emptying.

• Feeling of fullness or pressure in the rectum — some people report a persistent urge to pass stool even after a bowel movement.

Symptoms may come and go, and many people with haemorrhoids have no symptoms at all. However, if you notice rectal bleeding, persistent pain, or changes in bowel habits, it is important to seek medical advice to rule out other conditions such as colorectal cancer or inflammatory bowel disease.

Who is at risk of haemorrhoids in Singapore? 

Several groups of people are more likely to develop haemorrhoids due to specific risk factors. These include:

• Adults over the age of 45 — risk increases as rectal tissues lose elasticity with age.

• Pregnant women — hormonal changes and pressure from the growing uterus contribute to risk.

• Individuals with a family history of haemorrhoids — genetic predisposition may play a role.

• People who are overweight or obese — excess weight increases pressure on pelvic veins.

• Those with sedentary lifestyles — long hours of sitting can affect circulation and bowel habits.

• People with low-fibre diets — inadequate fibre intake can lead to harder stools and straining.

• Individuals who frequently experience constipation or diarrhoea — irregular bowel movements increase risk.

What are the possible complications of haemorrhoids? 

While many haemorrhoids resolve with conservative treatment, untreated or severe cases can lead to complications, including:

• Bleeding — persistent or heavy bleeding may lead to anaemia over time.

• Thrombosis — a blood clot can form within an external haemorrhoid, causing severe pain and swelling.

• Prolapse — internal haemorrhoids may protrude outside the anus and become difficult to push back in.

• Infection — irritated or damaged haemorrhoidal tissue can become infected, especially if hygiene is poor.

• Skin irritation or hygiene issues — persistent itching or difficulty cleaning the area may lead to discomfort.

• Strangulated haemorrhoid — in rare cases, a prolapsed haemorrhoid can have its blood supply cut off, leading to intense pain and tissue death.

How can I prevent haemorrhoids? 

Preventing haemorrhoids involves maintaining healthy bowel habits and making lifestyle adjustments that reduce pressure on the rectal veins. Practical steps include:

• Eating a high-fibre diet — consuming plenty of fruits, vegetables, and whole grains helps keep stools soft and regular.

• Staying well-hydrated — drinking enough water supports smooth digestion and prevents constipation.

• Exercising regularly — physical activity improves bowel function and reduces the risk of straining.

• Avoiding prolonged sitting or standing — taking regular movement breaks reduces pressure in the lower rectum.

• Responding promptly to bowel urges — delaying bowel movements can lead to harder stools and increased straining.

• Avoiding excessive straining on the toilet — gentle, unforced bowel movements reduce stress on the anal area.

• Maintaining a healthy body weight — lowers abdominal pressure and supports overall digestive health.

How are haemorrhoids diagnosed? 

Haemorrhoids are typically diagnosed through a physical examination and, if needed, further tests to rule out other conditions. The diagnostic process may include:

• Visual inspection — external haemorrhoids can often be seen during a clinical examination.

• Digital rectal examination (DRE) — the doctor gently inserts a gloved, lubricated finger into the rectum to feel for abnormalities.

• Anoscopy — a small, tube-like instrument is used to view the lining of the anal canal for internal haemorrhoids.

• Proctoscopy or sigmoidoscopy — proctoscopy or sigmoidoscopy may be recommended if there is rectal bleeding or to rule out other digestive issues such as polyps or colorectal cancer.

What are the treatment options for haemorrhoids in Singapore? 

Treatment for haemorrhoids is based on their severity and type (internal or external). Mild cases often respond to conservative measures, while more advanced haemorrhoids may require medical or surgical procedures. Common treatment approaches include:

Lifestyle changes 

Simple daily habits can make a significant difference in relieving symptoms and preventing the worsening of haemorrhoids. These include:

• High-fibre diet — helps soften stools and prevent straining.

• Adequate hydration — drinking enough water supports regular bowel movements.

• Regular exercise — promotes healthy digestion and reduces constipation.

• Avoiding prolonged sitting or straining — reduces pressure on rectal veins.

• Good toilet habits — responding promptly to the urge to pass motion and avoiding sitting too long on the toilet. 

Medications 

When lifestyle changes are not enough, medications can help manage discomfort and support healing. Common options include:

• Topical creams and ointments — contain ingredients such as hydrocortisone or witch hazel to reduce inflammation and discomfort.

• Suppositories — inserted into the rectum to soothe internal haemorrhoids.

• Oral medications — including painkillers or venotonic agents (e.g., flavonoids) to improve vein tone and reduce swelling.

Minimally invasive procedures 

The following outpatient treatments are suitable for internal haemorrhoids that do not respond to conservative measures and can remove them with minimal pain and recovery time: 

• Rubber band ligation — a rubber band is placed around the base of the haemorrhoid to cut off its blood supply, causing it to shrink.

• Sclerotherapy — a chemical solution is injected into the haemorrhoid to shrink it.

• Infrared coagulation — a heat source is used to cause scar tissue, cutting off the blood supply.

Surgical options 

When other treatments fail, surgery may be necessary to provide lasting relief and prevent recurrence. Common surgical methods include:

• Haemorrhoidectomy — surgical removal of internal or external haemorrhoids; considered the most effective for severe cases.

• Stapled haemorrhoidopexy — internal haemorrhoids are lifted and stapled back into place to reduce blood flow and reposition the tissue.

Treatment is usually tailored to the individual, depending on symptom severity, haemorrhoid type, and patient preferences.

Summary 

Haemorrhoids, also known as piles, are swollen veins in the lower rectum or anus that can cause discomfort, itching, bleeding, and pain during bowel movements. They are commonly triggered by factors such as straining during defecation, chronic constipation, prolonged sitting, or pregnancy. In Singapore, individuals at higher risk include older adults, pregnant women, those with a sedentary lifestyle, or a family history of haemorrhoids.

While many cases are mild and can be managed through lifestyle changes like a high-fibre diet, adequate hydration, and regular exercise, others may require medical treatments such as topical medications or minimally invasive procedures like rubber band ligation. Severe or persistent cases may need surgical intervention such as haemorrhoidectomy or stapled haemorrhoidopexy. 

If you are experiencing symptoms of haemorrhoids or would like a personalised treatment plan, schedule a consultation with Tan Siong San Surgery for proper diagnosis and care.