Haemorrhoids (Piles)

Swollen veins in the anus or rectum can cause pain, itching, or bleeding.

If symptoms persist or worsen, a colonoscopy may be needed to rule out other causes of rectal bleeding.

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What are Haemorrhoids?

Haemorrhoids are enlarged blood vessels located in the lower rectum and anus. While these vascular cushions are a normal part of human anatomy and help maintain continence, they can become problematic when swollen or inflamed. This leads to a condition known as haemorrhoidal disease or more commonly, piles.

Depending on their location and severity, haemorrhoids may cause discomfort, bleeding or protrusion from the anus. They are categorised as:

Internal haemorrhoids – occur within the rectum above the dentate line. These are typically painless but may cause bright red rectal bleeding.
External haemorrhoids – develop under the skin around the anus and are often associated with pain or itching.
Thrombosed haemorrhoids – result from a blood clot within an external haemorrhoid, often causing severe pain and swelling.

Internal haemorrhoids are further graded based on the extent of prolapse, which is:

Grade I – remains inside the rectum.
Grade II – prolapses during bowel movements but reduce spontaneously.
Grade III – requires manual reduction.
Grade IV – permanently prolapsed and non-reducible.

Haemorrhoids are swollen blood vessels in the anal canal that may cause bleeding, discomfort or lumps around the anus.

What causes Haemorrhoids?

Haemorrhoidal disease occurs when the blood vessels in the lower rectum and anus become swollen or irritated. This typically happens due to increased pressure within the pelvic or rectal area. This can compromise blood flow, stretch the supporting tissues and weaken the walls of these vessels over time.

Several factors may contribute to this pressure:

Chronic straining – straining during bowel movements, often due to constipation, an enlarged prostate or urethral narrowing, increases tension in the anal region and can damage haemorrhoidal vessels.
Passing hard stools or anal trauma – repeated passage of hard or dry stools can injure the anal lining, while activities such as anal intercourse or certain medical procedures can directly irritate or tear haemorrhoidal tissues.
Chronic cough – repeated coughing or respiratory effort raises intra-abdominal pressure, which can place continuous strain on the pelvic floor and veins around the anus.
Pelvic or abdominal masses – growths such as ovarian or colorectal tumours can compress surrounding structures and obstruct venous return, contributing to vein enlargement.
Pregnancy and childbirth – the combination of hormonal changes, increased pelvic pressure and pushing during labour makes haemorrhoids a common issue during and after pregnancy.
Frequent heavy lifting – lifting weights or objects with poor technique, can trigger a spike in abdominal pressure, especially if repeated over time.
Obesity or excess body weight – extra abdominal mass can impair circulation and elevate pressure on pelvic veins, making haemorrhoids more likely.

What are the symptoms of Haemorrhoids?

The symptoms of haemorrhoids depend on the severity of the condition, which can range from mild to severe pain.

Symptoms can vary based on the location and extent of the swollen veins in the anal or rectal area. This may include:

A hard, tender lump indicating a possible blood clot in the hemorrhoid
Bright red bleeding during or after bowel movements
Discomfort, pain or itching around the anus
Mucus discharge or a feeling of incomplete evacuation
Swelling or lumps near the anal opening

Who is at risk of developing Haemorrhoids?

While haemorrhoids can affect anyone, certain groups are more vulnerable due to physical, lifestyle or medical factors that increase pressure in the rectal area or compromise tissue strength. Some of these factors include:

Age – with age, the connective tissues that support haemorrhoidal veins naturally weaken, making it easier for veins to swell or prolapse under pressure. As such, haemorrhoids are more common among adults who are between 45 and 65 years old.
Family history – individuals with a genetic tendency towards constipation or weak connective tissue may have a higher risk of developing haemorrhoids.
Chronic constipation or diarrhoea – straining to pass hard stools or frequent loose motions can both irritate the anal canal and increase mechanical stress on haemorrhoidal tissues.
Inflammatory bowel disease (IBD) or colorectal conditions – chronic inflammation from conditions like Crohn’s disease, ulcerative colitis or rectal tumours may disrupt normal blood flow and weaken vein walls.
Pregnancy and childbirth – hormonal changes, pressure from the growing uterus and straining during delivery can all stretch or damage the veins in the anal canal.
Prior trauma or surgery – previous injury, anal procedures or repeated irritation can compromise the structural integrity of the anal tissues, making them more susceptible.
Certain types of exercise – high-pressure activities like heavy weightlifting or prolonged cycling can concentrate strain around the pelvic and anal region.
Obesity – excess body weight raises intra-abdominal pressure, which can impair venous return and promote haemorrhoidal swelling.
Low-fibre diets and inactivity – inadequate fibre intake leads to harder stools, while lack of physical activity slows bowel motility, both increasing the risk of straining.

If you are experiencing the symptoms,

consult a medical professional immediately.

Schedule an appointment with Dr Aaron Poh.

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How are Haemorrhoids diagnosed?

Dr Aaron Poh approaches haemorrhoid diagnosis with care and precision. Most cases can be identified through thorough consultation and simple in-clinic assessments, ensuring an accurate diagnosis without unnecessary discomfort. This entails:

History and symptom review – diagnosis begins with a detailed discussion about your symptoms, such as rectal bleeding, pain, itching or changes in bowel habits. Your medical and family history will also be considered to rule out related conditions.
Physical examination – a visual inspection of the anal area helps detect external haemorrhoids or prolapsed internal ones.
Digital rectal examination (DRE) – using a gloved, lubricated finger, Dr Aaron Poh may gently examine the rectum to feel for internal haemorrhoids, lumps or irregularities. This is done carefully to minimise discomfort.
Proctoscopy – a small, lighted instrument (proctoscope) may be used to examine the inside of the anal canal and lower rectum. This is especially helpful for detecting internal haemorrhoids or assessing the extent of prolapse.

How are Haemorrhoids treated?

Seeing a doctor for anal pain, bleeding or discomfort is always advisable as delayed treatment could lead to reduced quality of life.

Treatment for haemorrhoids depends on their type and severity. While many cases respond well to conservative measures such as lifestyle and dietary changes, more persistent or advanced haemorrhoids may require non-surgical or surgical intervention for lasting relief.

Some of the treatment options include:

Conservative management

Fibre-rich diet – softens stool and promotes regular bowel movements.
Hydration – essential to ensure that fibre works effectively to prevent constipation.
Exercise – aerobic exercises are preferable as they encourage bowel motility.
Sitz baths – soaking in warm water can ease pain and irritation.
Stool softeners/laxatives – help reduce straining during defecation.
Topical creams – over-the-counter creams containing hydrocortisone, lidocaine or vasoconstrictors provide symptom relief.

Non-surgical treatments

The procedures are performed in the clinic. However, these minimally invasive options are often recommended for internal haemorrhoids that do not respond to lifestyle changes:

Rubber band ligation – a rubber band is placed around the haemorrhoid to cut off its blood supply, causing it to shrink and fall off.
Sclerotherapy – a chemical injection shrinks the haemorrhoidal tissue.
Infrared coagulation – heat is used to shrink haemorrhoid tissue through coagulation.

Surgical options

When other treatments fail or in the case of large, painful or thrombosed haemorrhoids, surgery may be required:

Open haemorrhoidectomy – surgical removal of haemorrhoids as it is most effective for severe cases.
Stapled haemorrhoidectomy – uses a stapling device to reposition and cut off the blood supply to prolapsed haemorrhoids.

Schedule Your Appointment with Dr Aaron Poh.

Summary

Haemorrhoids are a common condition that can cause rectal bleeding, pain or a sense of fullness around the anus. While not life-threatening, they can significantly affect your quality of life if left untreated. Many cases improve with lifestyle and dietary changes. However, persistent symptoms may need further evaluation and treatment.

If you are experiencing rectal discomfort, bleeding or other bowel-related symptoms, contact us for a thorough assessment and a tailored treatment plan.

Frequently Asked Questions (FAQs)

Do haemorrhoids go away on their own?

Mild haemorrhoids may be resolved with lifestyle changes, like increasing fibre and water intake. Meanwhile, persistent or recurrent symptoms should be evaluated.

Are haemorrhoids a form of cancer?

No. Haemorrhoids are not cancerous. However, they can resemble symptoms of more serious conditions, so professional assessment is advised.

Can I push haemorrhoids back in myself?

Some prolapsed haemorrhoids (for example, Grade III) can be manually reduced. On the other hand, Grade IV haemorrhoids usually require medical intervention.

How long do haemorrhoids last?

With proper care, symptoms can improve within a few days to weeks. As for chronic or severe cases, medical treatment is required.

Is rectal bleeding always caused by haemorrhoids?

No. Bleeding can also occur due to fissures, polyps or colorectal cancer. That is why it is important to confirm the diagnosis with a doctor, as doing so ensures you receive a proper diagnosis and treatment.

Can pregnancy cause haemorrhoids?

Yes, due to increased pressure in the pelvic region and straining during delivery. However, they often resolve postpartum but may need treatment.

When should I see a doctor?

If you have ongoing bleeding, pain or any new bowel symptoms, seek medical attention. Remember: early diagnosis helps ensure effective and appropriate care.

Meet Our Doctor

DR AARON POH

Dr Aaron Poh is a fully accredited General Surgeon with dual subspecialties in Colorectal Surgery and Trauma Surgery, recognised by Singapore’s Specialist Accreditation Board and Ministry of Health. He is the Medical Director of Alpine Surgical Practice, with clinics located at Mount Elizabeth Hospital, Parkway East Hospital, and Farrer Park Hospitals.

Dr Aaron Poh has extensive experience, having performed over 5,000 endoscopic procedures. He is a strong advocate for early detection through colonoscopy, particularly for individuals at risk of colorectal cancer. His expertise includes advanced endoscopic techniques such as Endoscopic Mucosal Resection (EMR) for complex polyps and colonic stenting for obstructed cancers, which help patients avoid major emergency surgery.

When surgery is required, he specialises in minimally invasive laparoscopic colorectal cancer surgery, offering patients faster recovery with less pain and scarring. In addition to cancer care, he manages a wide range of anal conditions including haemorrhoids, fistulas, fissures, and abscesses, providing comprehensive colorectal treatment.