Mount Elizabeth Medical Centre,
Mount Elizabeth Novena Specialist Centre,
Gleneagles Medical Centre,
Mount Alvernia Hospital, Medical Centre D,
#14-09/10 Connexion,
Haemorrhoids, also known as piles, are swollen veins that form around the anal area. They can develop inside the rectum or on the skin surrounding the anus. Haemorrhoids are common and very rarely serious. Sometimes they are asymptomatic and resolve on their own, with people not even knowing that they have or had piles.
Some cases of haemorrhoids are more serious depending on their location and size. Haemorrhoids can be classified into degrees; each having a recommended piles treatment. For mild to moderate haemorrhoids, a change in diet and lifestyle may sometimes be enough to prevent them from worsening and new ones from developing. Surgery done by a piles surgeon is an option for more serious cases causing great discomfort.
Generally, haemorrhoids occur when excessive pressure is applied in the lower rectum. Such pressure is usually the result of overstraining during bowel movements or by simply sitting on the toilet for a prolonged period. Pregnancy, chronic diarrhoea or constipation and lifting heavy weights can also increase one’s risk of developing haemorrhoids.
Haemorrhoids can be grouped into four main types: internal haemorrhoids, prolapsed haemorrhoids, external haemorrhoids, and thrombosed haemorrhoids.
Internal haemorrhoids are swollen veins that develop deep within the rectum. Due to their location, they are not visible or palpable, and rarely cause noticeable symptoms due to the fact that there are no pain nerves in the rectum. Internal haemorrhoids are mostly harmless and go away on their own.
However, larger ones can cause symptoms such as pain, itching or a burning sensation. A lump may also be felt near the anus. There may be rectal bleeding as well during bowel movements. Sometimes, passing stool or overstraining while passing stool can push the internal haemorrhoid, causing it to protrude out the anal opening (prolapsed haemorrhoid).
Internal haemorrhoids that protrude or have been pushed out of the anus are called prolapsed haemorrhoids. Prolapsed haemorrhoids can be graded according to the extent of the protrusion:
- Grade I - Internal haemorrhoids with no prolapse.
- Grade II - Prolapse occurs when there is increased pressure in the rectal or anal area, such as straining when passing stool. However, the haemorrhoid retracts into the rectum on its own after a bowel movement.
- Grade III - Similar to Grade II, haemorrhoids stick out of the anus during bowel movements, but in this case, they don’t retract back on their own afterwards. Instead, they will need to be pushed back in.
- Grade IV - The prolapsed haemorrhoids protrude out of the anus and cannot be pushed back into their normal positions. At this stage, the haemorrhoids run the risk of becoming strangulated, a serious and emergency condition where blood supply to the haemorrhoid has been cut off due to pressure, resulting in intense and sudden pain.
The main symptom of a prolapsed haemorrhoid is the visible and protruding haemorrhoid itself. They are sometimes accompanied by pain, burning and itching. Depending on the grade, a prolapsed haemorrhoid can be treated through diet and lifestyle modifications, rubber band ligation, sclerotherapy or piles surgery.
External haemorrhoids are usually the first thing people think of when they hear the word haemorrhoids. These are visible and palpable lumps that form on the skin around the anus. They are similar to internal haemorrhoids in terms of symptoms, except that internal haemorrhoids are located inside the rectum.
However, because external haemorrhoids are formed outside of the body, symptoms like pain are more severe, and for some people, the symptoms can disrupt daily activities such as sitting, doing physical activities or during bowel movements.
A thrombosed haemorrhoid is an internal or external haemorrhoid in which a blood clot, called thrombus, is formed. Being a serious complication of an untreated haemorrhoid, a thrombosed haemorrhoid causes more severe symptoms, including intense pain, burning, itching, redness and swelling.
While not a life-threatening condition, thrombosed haemorrhoids require immediate medical attention. Its main treatment is a surgical procedure known as a thrombectomy, where the blood clot within the haemorrhoid is cut and drained. A thrombectomy is different from a haemorrhoidectomy or piles surgery, which is surgery to remove the haemorrhoid.
Haemorrhoids often disrupt one’s daily activities and affect their quality of life. At the onset of symptoms, such as pain, bleeding and a sensation of a lump in the anal region, it is best to seek the advice of a doctor for an accurate diagnosis and subsequent piles treatment. This will not only treat the piles, but it also rules out other conditions with similar symptoms like cancer.
Colorectal Practice is a clinic in Singapore that specialises in the treatment of colorectal conditions, including haemorrhoids. The clinic is headed by Dr Dennis Koh who is skilled in performing both non-surgical and surgical piles treatment such as haemorrhoidectomy and rubber band ligation. For enquiries and appointments, call 6262 1226.