- Chronic Constipation: Straining during bowel movements puts excessive pressure on anal blood vessels, leading to enlargement over time.
- Prolonged Sitting: Extended periods of sitting reduce blood flow to the anal area and increase pressure on the veins.
- Pregnancy: The growing uterus puts pressure on pelvic veins, while hormonal changes can cause vein walls to relax.
- Heavy Lifting: Regular lifting of heavy objects increases abdominal pressure and strains the anal area.
- Age: The supporting tissues in the rectum and anus weaken with age, making haemorrhoids more likely.
Haemorrhoids (Piles)
Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Haemorrhoids, also known as piles, are swollen blood vessels in and around the anus and lower rectum. These blood vessels can stretch under pressure, bulge, or become inflamed, causing discomfort, itching, and bleeding. While haemorrhoids often resolve on their own, they can significantly affect daily activities and quality of life when symptoms persist or worsen.
Symptoms Of Haemorrhoids
Recognising the signs of haemorrhoids allows for prompt medical attention and appropriate treatment selection.
- Rectal Bleeding: Bright red blood appears on toilet paper or in the toilet bowl during bowel movements. This bleeding occurs without pain and typically appears on the surface of the stool.
- Anal Itching: A persistent itching sensation occurs in the anal area due to irritation from enlarged blood vessels and mucus discharge.
- Pain or Discomfort: Sitting becomes uncomfortable, particularly with thrombosed haemorrhoids. The pain ranges from mild to severe based on the type and severity.
- Swelling: A hard, painful lump forms near the anus, indicating a possible thrombosed haemorrhoid. The area may appear blue or purple.
- Mucus Discharge: Clear mucus coats the anal area, leading to local irritation and soiling of underwear.
Causes and Risk Factors
Several factors may contribute to the development of haemorrhoids.
Types Of Haemorrhoids
Haemorrhoids are classified based on their location and characteristics, which affect treatment approaches.
Internal Haemorrhoids
Located inside the rectum, these haemorrhoids are graded from I to IV based on severity. Grade I remains inside the rectum, while Grade IV protrudes permanently outside the anal canal. Internal haemorrhoids often cause painless bleeding and may prolapse during bowel movements.
External Haemorrhoids
Form under the skin around the anus. These haemorrhoids can become painful, especially when thrombosed, and may cause significant discomfort during sitting or bowel movements. External haemorrhoids can also develop skin tags after healing.
Thrombosed Haemorrhoids
Occur when a blood clot forms within an external haemorrhoid. These present as a very painful, hard lump and require prompt medical attention. The pain typically peaks at 48-72 hours and gradually resolves as the clot dissolves.
Diagnostic Methods
Your piles specialist may employ any of the various methods to confirm the presence and severity of haemorrhoids.
Physical Examination
Your piles specialist performs a visual inspection of the anal area and digital rectal examination. This basic examination helps identify external haemorrhoids and assess for tenderness or abnormal growths.
Anoscopy
A small, lighted tube allows examination of the anal canal and lower rectum. This procedure enables direct visualisation of internal haemorrhoids and helps determine their grade and severity.
Sigmoidoscopy
When bleeding is present, this examination of the lower colon using a flexible, lighted tube rules out other potential causes. The procedure takes about 15 minutes and requires minimal preparation.
Treatment Options For Haemorrhoids
Treatment selection depends on haemorrhoid severity, type, and patient symptoms.
Non-Surgical Treatment
- Dietary Modifications: Increasing fibre intake and maintaining adequate hydration helps soften stools and reduce straining. A high-fibre diet typically includes 25-35 grams of fibre daily from fruits, vegetables, and whole grains.
- Sitz Baths: Sitting in warm water for 10-15 minutes, several times daily, reduces pain and inflammation. This treatment provides relief for both internal and external haemorrhoids.
- Topical Treatments: Over-the-counter creams, ointments, and suppositories containing hydrocortisone or witch hazel provide temporary relief from itching and pain. These medications should not be used for more than seven days.
Surgical Treatment
- Rubber Band Ligation: A rubber band placed around the base of an internal haemorrhoid cuts off blood supply. The haemorrhoid shrinks and falls off within a week, while the wound heals in two to four weeks.
- Hemorrhoidectomy: Surgical removal of large external haemorrhoids or grade III-IV internal haemorrhoids. Recovery typically takes two to four weeks, and results are usually permanent.
- Stapled Hemorrhoidopexy: A surgical stapling device removes and staples haemorrhoid tissue back in place. This procedure causes less pain than traditional hemorrhoidectomy but carries a higher risk of recurrence.
Are Your Symptoms Affecting Your Quality of Life?
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Prevention and Management
Regular physical activity promotes better bowel function and prevents constipation. Maintain good toilet habits by avoiding prolonged sitting on the toilet and responding promptly to bowel movements. When lifting heavy objects, engage abdominal muscles and avoid holding breath. Keep the anal area clean and dry, using unscented wipes or washing with warm water after bowel movements.
Frequently Asked Questions
Can haemorrhoids become cancerous?
Haemorrhoids do not develop into cancer. However, rectal bleeding should be evaluated by a medical professional to rule out other conditions, including colorectal cancer.
How long do haemorrhoids take to heal?
Small haemorrhoids may improve within a few days with home treatment. Larger haemorrhoids might take several weeks to heal completely, while surgical treatment recovery varies from two to six weeks.
Will haemorrhoids return after treatment?
Haemorrhoids can recur even after successful treatment. Maintaining dietary and lifestyle modifications helps reduce the risk of recurrence. Surgical treatments generally have lower recurrence rates than non-surgical options.
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Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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