Mount Elizabeth Medical Centre,
Mount Elizabeth Novena Specialist Centre,
Gleneagles Medical Centre,
Mount Alvernia Hospital, Medical Centre D,
#14-09/10 Connexion,
Piles, or haemorrhoids, are swollen blood vessels in the rectum and anus. Piles are very common and there are many types of piles treatments available to treat different types of piles. Piles should be treated as they can be a source of great discomfort, and may worsen in severity.
The recommended types of piles treatments will depend on the location and severity of the piles. Smaller haemorrhoids may resolve on their own, with symptoms manageable through diet and lifestyle modifications and medications. Piles whose symptoms do not improve with conservative treatments or are already causing significant pain may require surgery to treat. Surgery may be recommended for piles that have prolapsed (protruding through the anus) or are thrombosed (developed a blood clot).
Haemorrhoids can either be external, developing on the skin around the anus, or internal, developing inside the rectum. They can be further classified according to the degree of prolapse:
- Grade I - A haemorrhoid that causes mild discomfort, but does not protrude.
- Grade II - The haemorrhoid protrudes outside the anus when straining during bowel movements, but will return on its own afterwards.
- Grade III - The haemorrhoid protrudes outside the anus during bowel movements, but needs to be manually pushed back in.
- Grade IV - The haemorrhoid is prolapsed outside the anus and cannot be pushed back in. It also runs the risk of complications such as strangulation.
A colorectal surgeon will determine the appropriate treatment for haemorrhoids depending on their classification.
Most haemorrhoids can be treated through conservative treatments, including preventing constipation, soaking in sitz baths, applying topical ointments and more. However, when these treatments do not suffice, or when the haemorrhoids are already causing significant pain that disrupt one’s quality of life, piles surgery is recommended.
Piles treatments can be divided into two main categories: non-surgical and surgical.
Non-surgical treatments include:
- Medications and suppositories - Mild pain can be relieved using over-the-counter or prescribed pain relief medications. Topical and rectal suppositories may also be given to alleviate pain, itching and swelling.
- Rubber band ligation - Commonly known as banding, this procedure involves placing a band tightly around the base of the haemorrhoid. This cuts off the haemorrhoid’s blood supply, causing it to shrink and fall off naturally. Banding is typically done to address prolapsed piles.
- Energy ligation of haemorrhoidal arteries - This procedure is similar to a rubber band ligation, in which the goal is to shrink the haemorrhoid by cutting off its blood supply. The difference is that this technique typically uses heat energy. The discomfort that comes with technique is minimal.
Types of piles surgery include:
- Conventional excisional haemorrhoidectomy - The traditional method to treat piles, this procedure involves opening up the anus using surgical scissors or laser to remove the piles. The resulting wounds are left open to heal. A conventional excisional haemorrhoidectomy is done under general anaesthesia. As with open surgery, the recovery is longer and more uncomfortable than less-invasive methods.
- Closed-wound excisional haemorrhoidectomy - Similar to a conventional haemorrhoidectomy, a closed-wound excisional haemorrhoidectomy involves cutting away the haemorrhoid tissue. However, the resulting incision is sutured closed with absorbable stitches. This has a shorter and less painful recovery period.
- Stapled haemorrhoidectomy - This procedure is performed to treat internal and prolapsed haemorrhoids. It involves stapling the haemorrhoid back into its original position in such a way that its blood supply is also cut off. Stapling has a quicker recovery period than an excisional haemorrhoidectomy, but the chance of the haemorrhoid recurring is higher.
- Ligasure haemorrhoidectomy - This procedure is similar to a haemorrhoidectomy, with the exception that it also involves coagulating the tissue first before it is removed to help control the bleeding. Doing so minimizes the risk of complications and helps reduce blood loss and pain after surgery.
- Transanal haemorrhoidal dearterialization (THD) - THD is a minimally invasive procedure that involves using an anoscope and Doppler imaging to locate and ligate the haemorrhoid arteries, thus cutting of blood supply and causing the haemorrhoids to shrink.