Piles (Haemorrhoids) Treatment in Singapore

Many people live with piles for months or even years before seeking medical attention. What may begin as occasional bleeding, itching or discomfort during bowel movements can gradually become more frequent, making it uncomfortable to sit, exercise or carry out everyday activities. Although piles are common and often treatable, persistent or worsening symptoms should not be ignored, as they can affect your quality of life and may sometimes be mistaken for other colorectal conditions.

Whether your symptoms can be managed with conservative treatment or require surgery depends on the severity of your condition. A thorough assessment helps determine the most appropriate treatment to relieve symptoms and reduce the risk of recurrence.

What are Piles (Haemorrhoids)?

Piles, also known as haemorrhoids, are swollen and enlarged blood vessels in or around the anus and lower rectum. They are a common condition that can affect adults of all ages, although they become more common with age and during pregnancy.

Not all piles cause symptoms. Some remain small and go unnoticed, while others may lead to discomfort, itching, bleeding or protrusion during bowel movements. Depending on their location, piles are classified as either internal or external, and the severity of symptoms can vary from person to person.

Although piles are rarely serious, persistent or worsening symptoms should be assessed by a colorectal surgeon to confirm the diagnosis and determine the most appropriate treatment.

What are the Symptoms of Piles (Haemorrhoids)?

The symptoms of piles depend on their size, location and severity. While some people experience only mild irritation, others may develop symptoms that interfere with everyday activities.

Common symptoms include:

• Bright red bleeding during or after passing stools
• A lump around the anus that may be felt or seen
• Pain or discomfort, particularly when sitting or during bowel movements
• Itching or irritation around the anus
• Mucus discharge or difficulty keeping the anal area clean
• A feeling of incomplete bowel emptying or fullness after passing stools

Seek medical attention if you experience persistent rectal bleeding, severe pain or a lump that suddenly becomes swollen and very painful. These symptoms may indicate a thrombosed haemorrhoid or another condition requiring prompt assessment.

What are the Causes and Risk Factors of Piles (Haemorrhoids)?

Piles develop when increased pressure causes the veins in the lower rectum and anus to become swollen and enlarged. This pressure may result from repeated straining or other factors that place stress on the blood vessels in the anal canal.

Common causes and risk factors include:

• Chronic constipation and straining during bowel movements
• Prolonged sitting on the toilet
• Chronic diarrhoea
• Pregnancy and childbirth
• Obesity
• Ageing, which can weaken the supporting tissues around the anal canal
• Frequent heavy lifting
• A low-fibre diet that contributes to hard stools

Having one or more of these risk factors does not necessarily mean you will develop piles. However, making lifestyle changes, such as increasing dietary fibre, staying well hydrated and avoiding prolonged straining, may help reduce your risk or prevent symptoms from worsening.

What Are the Different Types of Piles (Haemorrhoids)?

Piles are classified according to their location. Understanding the type of haemorrhoid helps your colorectal surgeon determine the most appropriate treatment based on your symptoms and the severity of your condition.

How Are Piles (Haemorrhoids) Classified?

Internal haemorrhoids are classified into four grades according to the degree of prolapse. The grade helps determine the severity of the condition and guides treatment recommendations.

• Grade 1

  The haemorrhoid remains inside the anal canal and does not prolapse. Symptoms may include painless bleeding or mild discomfort during bowel movements.

• Grade 2

  The haemorrhoid prolapses during bowel movements or straining but returns inside on its own afterwards.

• Grade 3

  The haemorrhoid prolapses during bowel movements or physical activity and must be gently pushed back into the anal canal manually.

• Grade 4

  The haemorrhoid remains permanently prolapsed and cannot be pushed back inside. Grade 4 haemorrhoids are more likely to cause pain, swelling, bleeding and complications, and surgery is often recommended.

How Are Piles Diagnosed?

Diagnosing piles begins with a consultation and physical examination. Your colorectal surgeon will ask about your symptoms, including bleeding, pain, itching, prolapse and changes in your bowel habits. This helps determine whether your symptoms are caused by haemorrhoids or another colorectal condition.

The assessment may include:

• Visual examination to assess external haemorrhoids or prolapsed internal haemorrhoids.
• Digital rectal examination (DRE) to examine the anal canal and lower rectum.
• Anoscopy or proctoscopy, using a small instrument to examine internal haemorrhoids.
• Colonoscopy may be recommended for selected patients with persistent rectal bleeding, changes in bowel habits or other symptoms requiring further investigation.

A thorough assessment helps determine the type and grade of your haemorrhoids and guides the most appropriate treatment plan.

What Are the Treatment Options for Piles?

Treatment depends on the type and grade of your haemorrhoids, the severity of your symptoms and how much they affect your daily life. While many patients respond well to conservative measures or office-based procedures, surgery may be recommended for larger, prolapsed or recurrent haemorrhoids.

What to Expect Before, During and After Piles Surgery

Understanding what happens before, during and after piles surgery can help you prepare for your procedure and recovery. While every treatment plan is tailored to your condition and the surgical technique used, most patients follow a similar treatment pathway.

• Before Surgery

  Before your procedure, you will undergo a pre-operative assessment to ensure you are fit for surgery. This may include blood tests and a review of your medical history and current medications.
  
  Your surgeon will advise whether any medications, such as blood thinners, need to be temporarily adjusted before surgery. You will also receive instructions on fasting and whether bowel preparation is required, depending on the planned procedure.

• During Surgery

  Piles surgery is commonly performed under general or spinal anaesthesia, depending on the procedure and the patient's medical needs.
  
  The procedure performed will depend on the type and severity of your haemorrhoids. Whether your haemorrhoids are removed, repositioned or treated using a minimally invasive technique, your surgeon will recommend the most appropriate approach based on your condition.
  
  The procedure commonly takes around 30 to 60 minutes, although the duration varies depending on the technique used and the complexity of the condition.

• After Surgery

  After the procedure, you will be monitored in the recovery area until the effects of the anaesthesia have worn off. Many patients are able to return home on the same day, while others may require a short hospital stay depending on the procedure performed.
  
  It is normal to experience some discomfort, mild bleeding and swelling during the early stages of recovery. Pain relief medication and detailed aftercare instructions will be provided, and most patients are encouraged to resume light activities gradually while avoiding heavy lifting until advised by their surgeon. Follow-up appointments allow your recovery to be monitored and any concerns to be addressed.

What Are the Risks of Piles Surgery?

Piles surgery is a commonly performed procedure and is generally safe when performed by an experienced colorectal surgeon. However, like all surgical procedures, it carries some risks. Your surgeon will explain these during your consultation and discuss how they relate to your individual condition.

Potential risks specific to piles surgery include:

• Bleeding
• Persistent pain after surgery
• Temporary difficulty passing urine
• Narrowing of the anal canal, known as anal stenosis (uncommon)
• Changes in bowel control, such as temporary leakage of stool or gas (uncommon)
• Recurrence of haemorrhoids

Following your surgeon's post-operative instructions and attending follow-up appointments can help support a smooth recovery and reduce the risk of complications.

Can Piles Be Prevented?

While it may not always be possible to prevent piles, healthy bowel habits and lifestyle changes can help reduce your risk of developing them or prevent existing haemorrhoids from worsening.

Measures that may help include:

• Eating a high-fibre diet to keep stools soft
• Drinking plenty of water throughout the day
• Exercising regularly to promote healthy bowel function
• Avoiding prolonged straining during bowel movements
• Not delaying the urge to pass stools
• Limiting the time spent sitting on the toilet
• Maintaining a healthy body weight

If you continue to experience symptoms despite these measures, or if bleeding, pain or prolapse persists, seek medical assessment. Early assessment can help confirm the cause of your symptoms and allow appropriate treatment before they become more troublesome.