Ark Surgical Practice

Hemorrhoids Surgery / Piles

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What are Hemorrhoids / Piles?

Have you ever experienced the pain of hemorrhoids/ piles? It is an uncomfortable and embarrassing condition which affects one in three Singaporeans. Hemorrhoids (or commonly termed piles) consist of dilated blood vessels that are normally present in the anus. It is a common cause of Per Rectal bleeding or blood in stool. 

From the dilated blood vessels, the thinned-out wall tends to break easily thus leading to bleeding. As the condition worsens, it can also lead to the loss of elasticity in the supporting ligaments and thereby prolapse out of the anus initially during defecation and eventually not being able to reduce causing severe pain.

Hemorrhoids can be internal, located inside the rectum, or external, located under the skin around the anus. Internal hemorrhoids may not cause pain and often can only be detected during a physical examination or when they cause bleeding. External hemorrhoids, however, are visible and can cause pain, itching and burning sensations.

There are many factors that contribute to the development of piles. These include straining, constipation and lifestyle habits. Consequently, factors that predispose to these also contribute like the lack of fiber diet, lack of exercise and prolonged sitting. 

 

What are the Three Types of Hemorrhoids?

There are three different types of hemorrhoids. Knowing the differences between these types of can help you get the most effective treatment for your condition.

The first type of hemorrhoid is internal haemorrhoid, which occurs inside the rectum where it is not visible or palpable. Generally it does not cause any discomfort but straining when passing stools can damage the vein surface resulting in bleeding. In rare instances, straining can push the internal haemorrhoid out of the anal opening.

The second type of hemorrhoid is external haemorrhoid, which occurs around the anal area and is covered with sensitive skin. As there are more pain-sensing nerves in this area, external hemorrhoids can cause itching, bleeding, pain and irritation.

The third type of haemorrhoid is thrombosed haemorrhoid which happens when blood clots form in an external hemorrhoid. A thrombosed hemorrhoid feels like a hard and painful lump due to swelling and inflammation. Severe pain, itching and bleeding are also symptoms of a thrombosed hemorrhoid.

If you have been experiencing any symptoms related to hemorrhoids, it is important to see your doctor immediately. The earlier you get treatment, the better your chances of successfully treating the hemorrhoid and avoiding any potential complications. Depending on the type of hemorrhoid, your doctor may recommend lifestyle changes, medications or surgery.

 

What are Some of the Most Common Signs and Symptoms of Hemorrhoids / Piles?

When it comes to the symptoms of piles, it’s important to note that they can sometimes mimic and mask symptoms of cancer. This means that it’s important for anyone who is experiencing any type of unusual symptoms to speak to their specialist surgeon for a full examination before dismissing it as a mild and hemorrhoid-related issue.

Some of the most common symptoms of hemorrhoids include:

  • Bleeding – This is usually painless and can occur during or after a bowel movement. It may be bright red or a darker color.
  • Itching – The area around the anus may become itchy, and the skin may become inflamed, leading to soreness and discomfort.
  • Pain – Piles can be painful, especially if they become thrombosed (a blood clot forms inside the pile).
  • Mucus discharge – The area may secrete mucus, which can cause further irritation.
  • Swelling – Swelling in the area can be caused by the pile, and may cause discomfort.

If you’re experiencing any of the above symptoms, it’s important to consult a specialist surgeon for a full examination. They’ll be able to diagnose the condition and provide the best treatment plan for you. Treatment options can include lifestyle changes, such as dietary and exercise routines, or a combination of medications and minimally invasive procedures.

 

What are the Common Causes of Hemorrhoids?

The most common cause of hemorrhoids is straining during bowel movements. This occurs when the pressure in the lower rectum builds up due to pushing too hard to pass stool. This can cause the veins around the anus to stretch and bulge, forming hemorrhoids. 

In addition to this, sitting on the toilet for prolonged periods of time can lead to the development of hemorrhoids. When we remain seated for too long, the pressure in the lower rectum increases, which can cause veins to bulge or swell and form hemorrhoids. 

Chronic constipation and diarrhea can also result in hemorrhoids. When you’re struggling to pass stool, you’re likely to strain and put pressure on the veins around the anus. This can result in hemorrhoids. 

Being obese is another contributing factor to the development of hemorrhoids. When you’re carrying extra weight, it places greater pressure on your abdomen, which can lead to increased pressure in the lower rectum and the formation of hemorrhoids. 

Pregnant women are also at a higher risk for developing hemorrhoids. During pregnancy, the uterus enlarges, which can place additional pressure on the veins in the rectum and anus. This can cause them to bulge or swell and form hemorrhoids. 

Having anal intercourse is another possible cause of hemorrhoids. This is because anal sex can result in the rectal muscles being stretched beyond their normal limits, which can cause veins to bulge and swell. 

Eating a low-fiber diet is also a risk factor for hemorrhoids. A diet that is low in fiber can make it difficult to pass stool, which can increase the risk of straining during bowel movements and the development of hemorrhoids.

Finally, heavy lifting can also contribute to the development of hemorrhoids. Heavy lifting can increase the pressure in the lower rectum, which can cause veins to stretch and form hemorrhoids. 

 

What are the Risk Factors for Hemorrhoids?

One of the biggest risk factors for hemorrhoids is age. As you get older, the tissues that support the veins in the rectum and anus can weaken and stretch, making them more vulnerable to becoming swollen and inflamed. This means that your risk of hemorrhoids increases with age.

Another risk factor is pregnancy. The extra weight of the baby puts pressure on the veins in the rectum and anus, making them more likely to swell and become painful. Women who are pregnant, therefore, are at a higher risk of developing hemorrhoids than those who are not.

Other factors that can increase your risk of developing hemorrhoids include obesity, sitting for long periods of time, straining during bowel movements, chronic constipation, and a low-fiber diet. All of these things can cause the veins in your rectum and anus to become inflamed, leading to hemorrhoids.

If you are already experiencing hemorrhoids, there are treatments available to help reduce discomfort and pain. Over-the-counter medications can help reduce inflammation and swelling, and in more serious cases, your doctor may recommend surgical procedures to remove them.

If you think you may be at risk of developing hemorrhoids, it’s important to talk to your doctor. They can help you identify any potential risk factors and provide advice on how to reduce your chances of developing them.

 

What are the Possible Complications of Hemorrhoids?

While hemorrhoids can be painful and uncomfortable, it’s important to know that there are very few serious complications that can arise from having them. The most common complication of hemorrhoids is anemia. 

Anemia is caused when the blood loss from hemorrhoids is too large or chronic, which means that the body is not able to produce enough red blood cells to carry oxygen to cells. Symptoms of anemia can include fatigue, shortness of breath, and pale skin. 

Another potential complication of hemorrhoids is a strangulated hemorrhoid. This occurs when the blood supply to an internal hemorrhoid is cut off, which can cause extreme pain. Strangulated hemorrhoids usually require medical treatment and can be very uncomfortable. 

Finally, a blood clot may form inside of a hemorrhoid. This is known as thrombosed hemorrhoid. While it is not dangerous, it can be very painful and may require lancing and draining. 

 

How is Hemorrhoids Diagnosed?

Diagnosing hemorrhoids can be a daunting task, but it is important to have the problem diagnosed as soon as possible to prevent further damage and discomfort. The main ways that hemorrhoids are diagnosed are through digital examination, visual inspection, and in some cases, a bedside examination called an anoscopy.

Digital Examination

During a digital examination, your doctor will insert a lubricated and gloved finger into your rectum to feel for any abnormalities. This is the most common method of diagnosing hemorrhoids and can be done in the doctor’s office. This method is used to assess for external hemorrhoids, which can be felt during the examination.

Visual inspection

Because internal hemorrhoids are too soft to be felt during a rectal exam, your doctor may use a device called an anoscope, proctoscope or sigmoidoscope to examine the lower portion of your colon and rectum. These instruments allow your doctor to get a better view of the area and can be used to diagnose internal hemorrhoids.

Anoscopy

In some cases, an anoscopy may be used to help diagnose hemorrhoids. An anoscopy is an examination of the anal canal, which is inserted into the rectum to help determine if there are any abnormalities in the area. This procedure can be done in the doctor’s office and can help determine the size and location of the hemorrhoids.

Visual Inspection

If it is suspected that you have internal hemorrhoids, your doctor may perform a visual inspection of the lower portion of your colon and rectum. They may use an anoscope, proctoscope, or sigmoidoscope to get an up-close view. This will allow them to detect any growths or abnormalities that may be present.

Other Diagnostic Tests

In some cases, your doctor may order additional tests to confirm a diagnosis of hemorrhoids. These tests may include blood tests to check for anemia or infections, CT scans or MRIs to get a clearer view of the area, and sigmoidoscopies or colonoscopies to check for any abnormalities in the large intestine.

If you have any symptoms of hemorrhoids, such as bleeding, itching, or pain, it is important to speak to your doctor and get the issue diagnosed and treated. By getting the issue diagnosed as soon as possible, you can prevent further issues and get relief from your symptoms.

What are the Treatment Options for Hemorrhoids?

There are a variety of treatments available that can help provide relief and reduce symptoms. Depending on the severity, your doctor may recommend one or more of the following treatment options. 

Medications

Your doctor may recommend over-the-counter creams, ointments, suppositories, or pads to help reduce the pain and itching associated with hemorrhoids. These products often contain ingredients such as witch hazel, hydrocortisone, and lidocaine, which can provide temporary relief from the discomfort. It’s important to note that steroid creams should not be used for longer than a week without your doctor’s approval, as they can thin the skin. 

External Hemorrhoid Thrombectomy

In some cases, a painful blood clot may form in an external hemorrhoid. If this is the case, your doctor may recommend an external hemorrhoid thrombectomy. This procedure is done under local anesthesia, and it can provide immediate relief if done within 72 hours of the clot’s formation. 

Minimally Invasive Procedures

Your doctor may also suggest one of the following minimally invasive procedures to treat persistent bleeding or painful hemorrhoids:

  • Rubber Band Ligation: This procedure involves the use of a rubber band to cut off the blood supply to the hemorrhoid. The banded hemorrhoid then shrinks and falls off in a few days.
  • Sclerotherapy: With this procedure, your doctor injects a chemical solution into the hemorrhoid, causing it to shrink.
  • Infrared or Laser Coagulation: During this procedure, a device is used to deliver an infrared light to the hemorrhoid, which causes it to clot and shrink. 
  • Hemorrhoidectomy: This procedure is a more invasive option, in which the doctor surgically removes the hemorrhoid. 
  • Stapler hemorrhoidectomy: This procedure involves the use of a device that creates an excision of a ring of mucosa above the hemorrhoidal tissue. The end result is that the anal cushions are pulled up and the blood flow to the hemorrhoids are also interrupted. That leads to the shrinkage of the hemorrhoidal tissue and minimizes postoperative pain as the surgery is above the dentate line. 

Regardless of what treatment option your doctor recommends, it’s important to make sure that you follow their instructions carefully and avoid any activities that could make the condition worse.

Frequently Asked Questions

  • What can cause hemorrhoids to worsen?

    Hemorrhoids can worsen due to the following factors:

    1. Constipation
    2. Prolonged straining during defecation
    3. Low Fiber diet intake and dehydration 
    4. Alcohol intake
    5. Lifting of heavy weights

    These factors lead to an increase in effort to defecate.  An increased pressure in the rectum will then lead to dilatation of the veins around the anal region and lead to the worsening of the hemorrhoids. It is advised to avoid these factors when the patient is having active symptoms from hemorrhoids as they can lead to prolongation of duration of symptoms.  

  • How long will hemorrhoids last?

    Typically, hemorrhoidal symptoms last for about 3-5 days. Most of the symptoms resolve by themself, but taking medication can shorten the duration of symptoms.  However, it can last up to 2 weeks also depending on the severity. For piles that are prolapsing, it may persist even when the pain is resolved and medication in such cases will usually not be as effective.

  • How long will a hemorrhoid surgery take?

    It is usually very fast, especially for small hemorrhoids and straightforward cases. The entire procedure excluding the anesthesia and recovery is approximately 10 to 20 mins. Different procedures may take different lengths of time especially if there are additional steps taken to treat both internal and external hemorrhoids.

  • When is hemorrhoid surgery recommended?

    The indications for hemorrhoid surgery are divided into elective and emergency types. Elective cases will include failure of conservative treatment, symptoms affecting quality of life and patient’s choice. Emergency indications include bleeding piles, thrombosed piles and painful thrombosed piles.

  • Are hemorrhoids permanent?

    Most hemorrhoids are not permanent. Hemorrhoid tissues are actually blood vessels. And these have the propensity to dilate and constrict over time. Thus even when it is very dilated or painful, most piles should go for a course of conservative treatment and allow them to shrink prior to consideration for the need for surgery. 

    However, some piles especially external piles upon resolution will end up with skin tags in around the anus. These are not the same as piles and usually do not require excision. These tend to be very common after pregnancy and tend to be mistaken for piles.

  • Are hemorrhoids cancerous?

    No. Hemorrhoids are never cancerous. They also do not become cancerous. The hemorrhoids themselves are blood vessels and cancer in the anus or lower rectum come from glandular cells in the inner lining of the intestine. Both conditions are clearly from different origins and hence should not be confused as the same disease.

  • Can I live with hemorrhoids?

    Yes. In fact many people live with hemorrhoids and do not need any treatment. A consultation with a doctor like a GP is necessary though to ensure that the symptoms are not caused by other conditions. In our experience, there were rare cases where patients had a lump at the anus and thought they had piles. 

    As it never went away and got bigger, which is a red flag, they sought medical treatment eventually which was then noted to be a tumor. As they were promptly removed, patients continued to be well after surgery. This highlights the importance of an initial consult prior to the dismissal of symptoms.

  • What happens if I have hemorrhoids for too long?

    In general, hemorrhoids progress with age. However, many patients still do not require surgery even when the hemorrhoids are bigger or of a higher degree. (There are 4 degrees of piles) Thus nothing serious usually happens for patients with hemorrhoids for a long time. However, they may present with an acute problem like thrombosis or prolapse which is often very painful and rarely requires an emergency surgery.