Hemorrhoids (Piles)
Hemorrhoids are commonly known as piles. They are blood vessels in the anus that has become swollen. They can be divided into internal or external, depending on the location where they start.

What are Hemorrhoids / Piles?

Hemorrhoids are commonly known as piles. They are blood vessels in the anus that has become swollen. They can be divided into internal or external, depending on the location where they start. External piles develop at the outer part of the anus. It usually manifest itself when it forms a blood clot within, resulting in a painful swelling. The external feels like a hard, sensitive lump. Bleeding occurs only if the overlying skin ruptures. Internal piles starts from the upper part of the anal canal. It is believe that repetitive straining at stools 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. The blood vessel loses its elastic support and descend further down the anal canal and protrude outside of the anus. Once it is outside, it becomes a prolapsed hemorrhoid, which differs from the external piles.

What are the causes?

It is believed that the upright posture of humans alone raise the pressure in the veins and can predispose humans to hemorrhoids. 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 hemorrhoids without any symptoms and are not even aware that they have hemorrhoids. The symptoms also do not correspond well with the stage of the hemorrhoids. Some of the symptoms such as itching, bleeding or pain may be due to other conditions and not necessarily due to hemorrhoids. For example, bleeding may be due to colon cancer and pain may be due to anal fissure (tear).

How Serious is My Hemorrhoids?

Hemorrhoids 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 its become bigger and bulge out during bowel movement. However, the bulge disappears once straining stops.

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

Fourth degree, this 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?


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.


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.

How it can be treated?

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

For first or second degree, 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 doctor to relieve the symptoms.

If this does not help, further treatment may be required. This includes

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 hemorrhoidal artery ligation – uses an ultrasound probe to locate the arteries. A stitch is then used to tie off the artery. By interrupting the blood supply, the hemorrhoid shrivels up.

For 3rd and 4th degree, treatment includes

Hemorrhoidectomy - is the best method for the permanent removal. It is usually used for 3rd or 4th degree piles or 2nd degree that has failed other treatments such as ligation. There are numerous ways to perform hemorrhoidectomy

  • Conventional hemorrhoidectomy – involves cutting the piles from outside into the anal canal.
  • Staple hemorrhoidectomy – The hemorrhoids are pushed back into the anus and cut off on the inside. The cut edges are closed together by titanium staples. There is lesser pain compared with conventional hemorrhoidectomy.
  • Other techniques:
    laser hemorrhoidectomy is the use of laser to cut the hemorrhoids away in a manner similar to conventional hemorrhoidectomy. They do not offer any advantage over standard operative techniques and contrary to popular belief, are not less painful.

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

For more information, please visit www.piles.com.sg