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Piles (Haemorrhoids)

What are Piles?

Haemorrhoids (or piles), are swollen blood vessels located in the anus. It can be divided into internal or external, depending on the location where it starts.

External piles develop at the outer part of the anus. It usually manifests itself when it forms a blood clot within, resulting in a painful swelling. External piles feel like a hard, sensitive lump. Bleeding only occurs if the overlying skin ruptures. On the other hand, internal piles start from the upper part of the anal canal.

It is believed that repetitive straining causes a high pressure within and it becomes swollen. The wall of the blood vessel gets stretched and is thinned out and tends to break easily. Once this happens, bleeding occurs.

Repetitive straining also causes the supporting ligaments in the blood vessel to become overstretched and loses its elasticity. When the blood vessel loses its elastic support, it descends further down the anal canal and protrude outside of the anus.

Once it is outside, it becomes a prolapsed haemorrhoid, which differs from the external piles.

Piles can cause a lot of discomfort and should be treated promptly through a method that works best for your specific type and severity of piles.

What are the Causes?

It is believed that the upright posture of humans raises the amount of pressure in the veins and can predispose humans to piles. Other postulated factors include chronic constipation, ageing, pregnancy and childbirth.

What are the Symptoms?

  • Bleeding during bowel movements
  • Lump at the anus coming out during bowel movements
  • Persistent lump(s) at the anus
  • Itching in the anal area
  • Pain

There are many people with piles without any symptoms and are not even aware that they have the condition. The symptoms also do not correspond well with the stage of the piles. Some of the symptoms such as itching, bleeding or pain may be due to other conditions. For example, bleeding may be due to colon cancer and pain may be due to anal fissure (tear) .

How Serious are My Piles?

Piles are divided into 4 different degrees of severity. First degree is within the anal canal and there is no visible lump on the outside. Second degree occurs when it becomes bigger and bulges out during bowel movements. However, the bulge disappears once straining stops.

Third degree piles bulge out during bowel movements, but it stays out for a longer time before gradually going back into the anus, or the patient may push it back in after a bowel movement.

Fourth degree is the most advanced stage. The piles are out of the anus all the time and cannot be pushed back in.

What are the Complications?

Acute

This commonly occurs for the earlier degree where they become inflamed and swollen. This causes pain that may or may not be associated with bleeding.

Thrombosed

This occurs when the blood flow is interrupted. It usually happens when the piles prolapse out of the anus. The blood is unable to return to the body and clots. This results in severe pain and swelling.

More serious and symptomatic cases of piles should receive prompt medical attention so as to alleviate symptoms and prevent painful complications.

How is it Treated?

Piles that do not cause any symptoms do not require surgery.

For first- or second-degree piles, symptoms can be relieved by reducing straining during bowel movement. This could mean taking more fluids or laxatives. Oral medication or suppositories may be given by your piles surgeon to relieve the symptoms.

If this does not help, further treatment may be required for your piles . This includes the following piles surgery procedures:

  • Ligation

    – The rubber band treatment
  • Sclerotherapy

    – An injection is given to the area around the piles. This method is relatively painless and causes the piles to shrink.
  • Ultrasound Guided Haemorrhoidal Artery Ligation

    – The piles surgeon uses an ultrasound probe to locate the arteries. A stitch is then used to tie off the artery. By interrupting the blood supply, the haemorrhoid shrivels up.

For 3rd and 4th degree piles, treatment includes:

Haemorrhoidectomy

– Piles surgery is the best method for the permanent removal of more serious piles. It is usually used for 3rd or 4th degree piles or 2nd degree piles that have failed other treatments such as ligation. There are numerous ways to perform piles surgery:
  • Conventional Haemorrhoidectomy

    – Here, the piles surgeon cuts the piles from the outside and into the anal canal.
  • Stapled Haemorrhoidectomy

    – Here, the piles surgeon pushes the piles back into the anus and then cuts it off on the inside. The cut edges are closed together by titanium staples. There is lesser pain compared to conventional haemorrhoidectomy.
  • Other Techniques

    – Laser haemorrhoidectomy or laser piles surgery uses laser to cut the piles away in a manner similar to conventional haemorrhoidectomy. They do not offer any advantage over standard operative techniques and contrary to popular belief, are not less painful.

Haemorrhoid Energy Transfer (HET)

– This is a new technique that uses a special device to burn off the piles.

Other piles treatments include cryotherapy, BICAP coagulation and direct current to shrink the piles. None of these treatments have gained widespread acceptance.

For more information, visit our website on Piles Surgery.


Our Singapore Piles
Surgeon
Dr Ho Kok Sun
Colorectal & General Surgeon
MBBS (Singapore), M Med (Gen Surg) (Singapore), FRCSEd (Gen Surg), FAMS
Dr Ho Kok Sun has been committed to treating piles and haemorrhoids for over a decade, through the use of both surgical and non-surgical means. Dr Ho was the past President of the ASEAN Society of Colorectal Surgeons and the Society of Colorectal Surgeons (Singapore), as well as a founding member of the Eurasian Colorectal Technologies Association. Dr Ho was actively involved in the training of medical students and residents, and has published widely in reputable journals and book chapters. He believes that treatment should always be personalised to the patient’s needs.
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Colorectal Surgeon
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Mount Elizabeth Medical Centre
#12-09, Singapore 228510

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