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Haemorrhoids: What is it

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 inside.

Risk Factors of Haemorrhoids

Haemorrhoids are very common. They affect nearly half of the population at some stage in their lives.

Causes of Haemorrhoids

Haemorrhoids are caused by pressure on the veins in the pelvic and rectal areas causing them to swell and stretch.

Prevention of Haemorrhoids

  • Increase fibre intake. Fruits, vegetables and cereals soften the stools and increase the bulk so that straining can be avoided.
  • Drink plenty of fluids. At least six glasses of water daily helps to keep the stools soft.
  • Don’t strain. Straining when passing stools puts pressure on the veins in the rectum.
  • Don’t hold. Holding off when you feel the urge could make your stools dry and harder to pass.
  • Exercise. Regular moderate exercise, together with a high fibre diet, promotes regular bowel movements.
  • Avoid long periods of sitting and standing. Extended periods of standing and sitting increase the pressure on the veins in the rectum.

Contributing factors can include:

  • Ageing
  • Chronic constipation or diarrhoea
  • Pregnancy
  • Hereditary
  • Faulty bowel function due to overuse of laxatives
  • Straining during bowel movements
  • Spending long periods of time in toilet

Symptoms of Haemorrhoids

  • Bright red blood dripping during bowel movements - may stain the toilet paper
  • Lump at the anus coming out during bowel movements
  • Itching in the anal area
  • Pain
  • Sensitive lump

Diagnosis of Haemorrhoids

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.

Treatment of Haemorrhoids

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 or protruding.

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 haemorrhoids.

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 bleeding.

A hemorrhoidectomy removes excessive tissue that causes the bleeding and protrusion. It is done under anaesthesia and usually requires hospitalisation.

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 institution:

Singapore General Hospital
Tel: 6321 4377