Also known as ‘piles’,
haemorrhoids are abnormally
enlarged and bulging blood
vessels in and around the anus
and lower rectum.
There are two types of haemorrhoids –
external (near the opening of the anus)
and internal (inside the anal canal).
External haemorrhoids develop
near the anus and are covered by very
sensitive skin. If a blood clot develops
in one of them, a painful swelling may
occur. The external hemorrhoid feels
like a hard, sensitive lump. It bleeds
only if it ruptures.
Internal haemorrhoids develop
within the anus beneath the lining.
Painless bleeding and protrusion
during bowel movements are the
most common symptoms. However, an
internal hemorrhoid can cause severe
pain if it protrudes from the anal
opening and cannot be pushed back
Haemorrhoids are very common. They
affect nearly half of the population at
some stage in their lives.
Haemorrhoids are caused by pressure
on the veins in the pelvic and rectal
areas causing them to swell and stretch.
Contributing factors can include:
Your doctor will make the diagnosis
based on a physical examination.
For internal haemorrhoids, your
doctor may need to use an anoscope,
proctoscope or sigmoidoscope, which
are special tubes inserted into the anus
after lubrication, to allow the anus and
rectum to be visualised.
Mild symptoms can be often be
relieved by increasing your intake
of fibre and fluids. This decreases
straining during motion so that the
pressure on haemorrhoids is reduced.
This helps prevent them from bleeding
If this does not work, then ligation
and injection can be considered. Both
these procedures can be done in your
doctor’s clinic without hospitalisation.
Ligation works best on internal
haemorrhoids that protrude with
bowel movements. A small rubber
band is placed over the haemorrhoid
to cut off its blood supply. The
haemorrhoid and band will fall off in a
few days and the wound usually heals
in a week or two. Ligation is performed
without the need for hospitalisation.
Injection can also be used on
bleeding haemorrhoids that do not
protrude. This method is relatively
painless and causes the haemorrhoids
to shrivel up. Hospitalisation is not
required for this procedure.
Haemorrhoidectomy is the best
method for permanent removal of
It is necessary under the following
circumstance: when clots repeatedly
form in external hemorrhoids; ligation
fails to treat internal hemorrhoids;
the protruding hemorrhoid cannot
be reduced; or there is persistent
A hemorrhoidectomy removes
excessive tissue that causes the
bleeding and protrusion. It is done
under anaesthesia and usually requires
Stapled Haemorrhoidectomy uses a
specialised circular stapler to remove
the haemorrhoids. The advantages of
this procedure are that it is less painful
than conventional procedures yet
offers the convenience of day surgery.
A better outcome is also achieved
with the excision of the haemorrhoids,
especially for larger-sized ones.
Do haemorrhoids lead to cancer?
There is no relationship between
haemorrhoids and cancer.
However, as the symptoms
of haemorrhoids, particularly
bleeding, are similar to that
of colorectal cancer and other
diseases of the digestive system,
it is important that you have all
symptoms investigated by a doctor.
See a doctor to correctly diagnose
your symptoms and to have the
correct treatment prescribed.
Please consult your Family Doctor if you have any concerns
about your health.
Specialist services available at the following SingHealth
Singapore General HospitalTel: 6321 4377
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