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Piles/Haemorrhoids

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What are Piles/Haemorrhoids?

There are veins all over our body, this includes the anus and lower rectum. Piles/Haemorrhoids are pillow-like clusters of veins situated at the lower rectum and anus. Usually, these piles/haemorrhoids are not swollen and hence do not cause any problems.

However, sometimes these pillow-like cluster veins become swollen or enlarged, resulting in the condition we commonly refer to as piles/haemorrhoids. Piles/haemorrhoids are the most common medical condition in Singapore. By the age of 50, 50% of individuals would have experienced piles/haemorrhoids.

There are two types of piles/haemorrhoids: 

  • Internal: forms in the lining of the anus or lower rectum and usually do not cause any pain.
  • External: most common type and it forms under the skin around the anus. External haemorrhoids can be very uncomfortable if the skin around the anus becomes inflamed and breaks down.

What causes Piles/Haemorrhoids?

Piles/haemorrhoids can be caused when the cluster of veins around the anus or rectum swells up and gets engorged. This can occur due to a number of factors either individually or in combination with each other, such as:
  • Constipation: usually if an individual has constipation, he/she will end up straining and pushing the hard stool. This can result in increased pressure on the veins surrounding the rectum and anus, which causes them to become swollen and engorged.
  • Prolonged sitting on the toilet bowl: sitting for a prolonged amount of time can result in increased pressure on the veins of the anus and rectum, causing them to swell and enlarge.
  • Weight: being obese will increase the amount of pressure on the veins around the anus and rectum, causing them to swell.
  • Pregnancy: the enlarged uterus pressing down on the veins of the colon can cause them to swell.
  • Anal intercourse: this can irritate the piles/haemorrhoids
  • Regular heavy lifting: lifting heavy things can put a large amount of pressure on the veins of the colon and cause them to swell.

What are the common symptoms of Piles/Haemorrhoids in Singapore?

Internal piles/haemorrhoids usually do not cause any pain unless they have prolapsed (slipped down from their original position). They can cause rectal bleeding which can be observed if you have bloody stools or the presence of blood in the toilet bowl or after wiping.

Symptoms of external piles/haemorrhoids include:

  • Rectal bleeding: occurs for both internal and external piles/haemorrhoids.
  • Itchy anus: can be due to inflammation or friction from toilet paper and clothes
  • Lumps near the anus: they may feel sore, tender, and sensitive to the touch 
  • Pain in the anus: more pronounced when you sit

Are piles/haemorrhoids painful?

Most of the time, piles/haemorrhoids do not cause any pain. However, if an internal pile/haemorrhoid prolapses or an external pile/haemorrhoid forms a blood clot on the skin (also known as a thrombosed haemorrhoid), then it can cause a significant amount of pain.

Who is at risk of piles/haemorrhoids in Singapore?

There are various factors that increase your risk of getting piles/haemorrhoids, these are:

  • Age: your risk of haemorrhoids increases as you age.
  • Obesity: increases the pressure on your pelvic region and anal veins, causing them to become swollen and engorged.
  • Pregnancy: pregnant women have an increased risk of piles/haemorrhoids due to the weight and pressure of the uterus, however, this risk decreases after giving birth.
  • Family history: your risk increases if you have family members with piles/haemorrhoids.

How are Piles/Haemorrhoids diagnosed?

A visual examination will be sufficient for the diagnosis of piles/haemorrohoids, but your gastroenterologist may conduct the following tests for a more accurate diagnosis:

  • Digital rectal exam: your gastroenterologist will insert a gloved and lubricated hand into your rectum to check for anomalies. 
  • Colonoscopy: a thin and flexible tube with a camera and light attached at one end, is inserted into the anus and led up through the rectum and large intestine for a proper examination. 
  • Sigmoidoscopy: used to examine the insides of the rectum and anus.

What are the treatment options for Piles/Haemorrhoids in Singapore?

Piles/haemorrhoids may be treated at home by eating more fibre, taking pain relief medications, or soaking in a warm bath. However, these may be inadequate for some people, as such, there are some treatment options that can be performed by your gastroenterologist:

  • Rubber band ligation: used to treat bleeding or prolapsed piles/haemorrhoids. A special medical grade rubber band is tied around the base of the pile/haemorrhoid. Blood circulation is cut off and eventually the pile/haemorrhoid will shrivel and fall off. 
  • Sclerotherapy: a solution is injected into the internal pile/haemorrhoid. This solution causes scar tissue to form which cuts off the blood supply to the pile/haemorrhoid, shrinking it.
  • Infrared photocoagulation: infrared light is shined into the internal haemorrhoid, causing scar tissue to form which cuts off the blood supply to the pile/haemorrhoid, shrinking it.
  • Electrocoagulation: an electric current is applied to the internal pile/haemorrhoid, causing scar tissue to form which cuts off the blood supply to the pile/haemorrhoid, shrinking it.
  • Hemorrhoidectomy: used for large external piles/haemorrhoids or prolapsed internal piles/haemorrhoids.
  • Haemorrhoid stapling: stapling tool is used to remove internal piles/haemorrhoids or to pull a prolapsed internal pile/haemorrhoid back into the anus.

Frequently asked questions

Can piles/haemorrhoids go away on their own?
If the piles/haemorrhoids are small, they can go away by themselves but if they are too big, treatment may be needed.
Can piles/haemorrhoids be permanently cured?
There is no way to guarantee that you will never ever get piles/haemorrhoids but you can reduce your risk by following a high fibre diet, drinking plenty of water, leading a healthy lifestyle, and not spending too long sitting on the toilet bowl.

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