Medical Director
Senior Consultant, General & Colorectal Surgeon
MBBS (Singapore), MRCS (Edinburgh), MMed (Surgery), FRCS (Edinburgh)
Piles (or haemorrhoids) are very common in Singapore. They are characterised by pain and a sensation of a lump in the anal region, as well as bleeding during bowel movements.
Piles are enlarged blood vessels found within the inner lining of the rectum or the surface of the anus. Some may be located within the anal canal, while some may protrude outside of it.
Typically, these blood vessels do not cause any issues. However, with repeated and/or excessive pressure (e.g. chronic constipation, childbirth), the blood vessels may swell and become inflamed. And as the walls of the blood vessels stretch, they may break under pressure, resulting in bleeding.
Dr Chew is an experienced piles surgeon in Singapore who has been involved in various research studies evaluating the effectiveness and safety of various haemorrhoid surgical procedures.
What are the Types of Piles?
Internal Piles
These piles develop within the rectum and usually do not cause any pain or discomfort. However, some may protrude from the anal canal upon straining. In mild cases, the piles can be manually pushed back in; in more serious cases, the protruding piles are unable to be pushed back into the anal canal.
External Piles
External piles develop around the anus, and is characterised by a lump near or around the anus. They may cause pain, itching and bleeding; and are not reducible. External piles are at risk of developing sudden and painful blood clots (thrombosis).
Thrombosed Piles
Thrombosed piles are piles that are filled with blood clots. They present with severe symptoms such as intense pain, burning, itching and swelling. They must be quickly treated to prevent the loss of blood supply and tissue damage.
Causes of Haemorrhoids
Piles are swollen veins in the lower rectum or anus, often caused by increased pressure in the area.
Chronic Constipation or Diarrhoea: Both conditions lead to frequent straining during bowel movements, which increases pressure on the rectal veins.
Straining During Bowel Movements: This is often associated with constipation and can cause veins to swell.
Pregnancy: The growing uterus and hormonal changes increase pressure on the rectal veins.
Ageing: Weakening of the supporting tissues in the anus and rectum can occur with age.
Low-Fibre Diet: A diet lacking fibre can lead to constipation and straining.
Prolonged Sitting: Spending long periods sitting, especially on the toilet, can cause venous return issues.
Obesity: Excess body weight increases pressure on the rectal veins.
Sedentary Lifestyle: Lack of physical activity can contribute to poor circulation and increase the risk of piles.
Genetic Predisposition: A family history of piles can increase the likelihood of developing them.
Heavy Lifting: Frequently lifting heavy objects can increase intra-abdominal pressure.
Pelvic Floor Dysfunction: Weakness in the muscles supporting the pelvic organs can contribute to haemorrhoids.
What are the Symptoms of Piles?
Common symptoms of piles include pain and itching in the anal area, blood on the toilet paper or in the toilet bowl after a bowel movement, a sensation of a lump near the anus, as well as mucus discharge from the anus.
If you notice signs and symptoms of piles,
Make an appointment with our doctor for an accurate diagnosis and personalised treatment.
What are the Different Grades of Piles
Haemorrhoid grading reflects the degree of haemorrhoidal prolapse and is a key factor in determining appropriate management. These can range from Grade I, which involves haemorrhoids without prolapse, to Grade IV, where prolapsed haemorrhoids cannot be manually reduced.
Grade 1
These hemorrhoids are slightly enlarged and do not protrude outside the anus. They may cause minor bleeding but are often asymptomatic.
Grade 2
These hemorrhoids protrude outside the anus during straining, such as during bowel movements, but retract back inside on their own. They may cause discomfort or bleeding.
Grade 3
These hemorrhoids prolapse during straining and do not retract automatically. They require manual pushing back into the rectum and can cause pain and bleeding.
Grade 4
These are the most severe, permanently prolapsed hemorrhoids that remain outside the anus and cannot be manually reduced without significant pain. They often require surgical intervention.
Potential Complications of Untreated Piles
If left untreated, haemorrhoids can lead to a variety of complications that range from mild discomfort to severe health issues. These complications can significantly impact quality of life and, in some cases, require immediate medical attention. These potential issues include:
Anaemia:
Chronic blood loss from haemorrhoids can lead to iron deficiency anaemia. This condition results in a lack of healthy red blood cells, causing symptoms like fatigue, weakness, and shortness of breath.Infection:
Untreated haemorrhoids can develop into open sores or ulcers, which can become infected. This requires medical attention, often involving antibiotics.Prolapsed Hemorrhoid:
Prolapsed hemorrhoids occur when they protrude from the anus and cannot be pushed back in. This condition can cause significant discomfort and bleeding.Strangulated Haemorrhoid:
Strangulated haemorrhoids occur when the blood supply to a prolapsed haemorrhoid is cut off, leading to tissue damage and potentially life-threatening infections like sepsis.Blood Clot:
Blood clots can form in haemorrhoids, particularly in thrombosed ones, causing pain and swelling. These clots can lead to further complications if not treated promptly.How are Haemorrhoids and Piles Diagnosed?
To diagnose haemorrhoids, a doctor will first conduct a physical examination. This typically involves a visual inspection of the anus and surrounding area. If internal haemorrhoids are suspected, they may perform a digital rectal exam, in which the doctor will gently insert a lubricated and gloved finger into the rectum to feel for the presence of haemorrhoids. In a few cases, an additional test called a sigmoidoscopy or colonoscopy might be recommended to rule out other serious causes of bleeding, such as colorectal polyps or cancer.
Piles Treatment Singapore
Haemorrhoids treatment varies depending on the type and severity of the piles. Piles or haemorrhoid surgery will only be needed in more advanced cases, and your surgeon will be in the best position to determine the type of piles treatment you need.
Non-Surgical Treatment
- This centres around reducing constipation and symptomatic relief. You may be recommended to increase your fibre intake (not excessively) or take laxatives in order to soften your stools. You may also try sitting in a warm sitz bath to help relax the anal muscles, provide pain relief and improve blood flow. Topical creams or oral medication may also be used to temporarily ease inflammation and itching and other symptoms.
Minimally Invasive Procedures
- Should the above conservative methods not work, your piles surgeon may recommend minimally invasive treatments such as rubber band ligation.
- In the first method, a rubber band will be placed around the base of the piles, restricting its blood supply and causing it to wither and die off within a few days.
Piles Surgery Singapore
In cases where the above conservative and minimally invasive methods prove insufficient, piles surgery (haemorrhoidectomy) may then be recommended. This can be mainly done through the conventional, stapled method or via a new method known as laser haemorrhoidectomy.
Conventional Haemorrhoidectomy
- The conventional method has been used for many years and is an effective method for the excision of the piles and skin tags. This method of piles surgery is suitable for many types of piles and is still commonly performed.Stapled Haemorrhoidectomy
- In the stapled method, the piles are removed through a circular stapling device without the need for an incision. Piles excised in this fashion have been reported to have less postoperative pain. Speak to us to find out if you are suitable for this.Transanal Haemorrhoidal Dearterialisation
- Transanal Haemorrhoidal Dearterialisation (THD) is a minimally invasive procedure that involves locating the arteries that supply blood to the haemorrhoids using a Doppler ultrasound probe. Once located, the surgeon ties off these arteries, thus stopping the blood flow to the haemorrhoids, causing them to shrink and eventually disappear.LigsaSure Haemorrhoidectomy
- This is a type of haemorrhoid surgery that uses advanced technology to remove haemorrhoids. In this procedure, a special device is used to apply precise amounts of heat to seal off the blood vessels supplying the haemorrhoids.Laser Haemorrhoidoplasty
- In one of the newest methods, laser haemorrhoidectomy has been performed by our piles surgeon. This method requires a small incision and insertion of a laser probe into the pile. The initial results suggest equivalent short-term outcomes but with less postoperative discomfort.
What are the Risks of Haemorrhoid Surgery?
Haemorrhoid surgery, like any medical procedure, comes with certain risks that one should be aware of. This includes temporary pain and bleeding, infection, anal stricture, recurrence of haemorrhoids, or faecal incontinence caused by damage to the anal sphincter muscles. However, in experienced hands, the risk of complications is rare. Most people recover smoothly, especially when they follow proper postoperative care instructions.
Piles Treatment: Post-Surgery Care
After haemorrhoid surgery, post-operative care is key to ensuring a smooth and speedy recovery.
Pain Management:
You will be given medications to alleviate the pain. You may also be given stool softeners to ensure that you do not develop hard stools, which are painful and can also hinder healing.Hygiene:
Keeping the anal area clean is key to preventing infection. You may be advised to take a warm sitz bath, especially after bowel movements. This can help soothe the area and keep it clean.Activity:
While rest is important, gentle activities such as short walks can promote blood circulation and speed up recovery. However, avoid heavy lifting and strenuous exercise until your colorectal doctor clears you to do so.Follow-up Checks:
Attend all follow-up appointments so that your doctor can monitor your healing and address any concerns you may have.Lifestyle Changes:
To prevent the recurrence of haemorrhoids, you should maintain a balanced, high-fibre diet, stay hydrated, get regular exercise, and avoid long periods of sitting.
FAQs on Haemorrhoids (Piles)
When is surgery needed for piles/haemorrhoids?
Can sitting on hot surfaces cause piles?
Can spicy foods contribute to the development of piles?
Can piles recur even after receiving treatment?
Can stress worsen piles?
What happens if piles are left untreated?
Do haemorrhoids lead to cancer?
Helpful Links
Our Piles Surgeon in Singapore
Dr Chew Min Hoe
Medical Director
Senior Consultant, General & Colorectal Surgeon
MBBS (Singapore), MRCS (Edinburgh), MMed (Surgery), FRCS (Edinburgh)
Dr Chew Min Hoe is a Senior Consultant in General & Colorectal Surgery, with over 20 years of experience both public healthcare and private practice. He has niche interests in colorectal cancer, advanced pelvic tumours, hereditary conditions, and perianal surgery, which includes haemorrhoids treatment. Dr Chew has been involved in various research studies evaluating the effectiveness and safety of haemorrhoid surgical procedures, highlighting his expertise as a piles surgeon.
Key Publications
Chew MH; Tan WS; Eu KW
The use of CEEA 34 in stapled hemorrhoidectomy: suggested modifications in technique.
World journal of surgery 2008; 32(6):1160-1111 (Article; Published in Print)
Ng KH; Chew MH; Eu KW
Modified stapled haemorrhoidectomy: a suggested improved technique.
ANZ journal of surgery 2008; 78(5):394-377
Chew MH; Chiow A; Tang CL
Keloid formation after stapled haemorrhoidectomy causing anal stenosis: a rare complication.
Techniques in coloproctology 2008; 12(4):351-322 (Letter; Published in Print)
Chew MH; Kam MH; Lim JF; Ho KS; Ooi BS; Tang CL; Eu KW
The evaluation of CEEA 34 for stapled hemorrhoidectomy: results of a prospective clinical trial and patient satisfaction.
American journal of surgery 2009; 197(6):695-701 (Article; Published in Print)
Our Motto
Caring Hearts, Educated Minds, Skilled Hands
Orchard
3 Mount Elizabeth #16-09, Mount Elizabeth Medical Centre,Singapore 228510
Tel:+65 6518 4688
Fax:+65 6235 0897
Mon-Fri:8:30am - 5:30pm
Sat / PH Eve:8:30am - 12:00 noon
Sun & Public Holiday: Closed
Farrer Park
1 Farrer Park Station Road Connexion,#08-07 Farrer Park Medical Centre,Singapore 217562
Tel:+65 6518 4868
Fax:+65 6443 6616
Mon-Fri:8:30am - 5:30pm
Sat / PH Eve:8:30am - 12:00 noon
Sun & Public Holiday: Closed
