Haemorrhoids, or piles, are enlarged tissue cushions in the anus as a result of enlarged or congested blood vessels. While it is normal to have these tissue cushions, they can become problematic when enlarged.
Haemorrhoids are often confused with skin tags, as both can often be felt at the edge of the anus. But while haemorrhoids arise from within the anus, skin tags occur in the skin around the anus.
Internal haemorrhoids occur in the lower rectum. Prolapsed internal haemorrhoids push down from the rectum and bulge out from the anus.
External haemorrhoids develop under the skin around the anus. External haemorrhoids are most uncomfortable, as the overlying skin can become irritated and erode.
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Symptoms of piles include:
Causes of piles include:
One of the commonest symptoms of haemorrhoids is bleeding during the passing of motion. Early medical consultation with consideration for a colonoscopy is essential, particularly for individuals over 40 years of age, to achieve an accurate diagnosis. Colon/Rectal tumour bleeding can resemble haemorrhoidal bleeding and the differentiation between the two is essential.
If you’ve experienced persistent symptoms for a week or more, it's time to talk to a doctor.
Additionally, please seek medical attention if you have the following symptoms:
First-degree haemorrhoids are the smallest in size and do not prolapse. These are usually residing within the anus and is best treated with medications. No form of surgical intervention is helpful due to the small size
Second-degree haemorrhoids may prolapse/’drop out’ during the passing of motion but they tend to reduce/’go back’ into the anus after passing motion.
The treatment options include:
1. Medications for the smaller second-degree haemorrhoids.
2. Ligation (tying up with rubber bands) for small to medium-sized second-degree haemorrhoids)
3. Stapled haemorrhoidectomy or the THD/HALO procedure for large second-degree haemorrhoids
Third-degree haemorrhoids are larger than second-degree ones and hence ‘drop out’ during the passing of motion but will require the patient to push them back manually. Third-degree haemorrhoids do not reduce/’go back’ by themselves.
Third-degree haemorrhoids also certainly require some form of surgery as they are too large to shrink sufficiently with either medications or rubber band ligation.
The surgical options include stapled haemorrhoidectomy (for smaller third-degree haemorrhoids), or more commonly a conventional haemorrhoidectomy (Milligan-Morgan or Ferguson method).
Fourth-degree haemorrhoids are the largest haemorrhoids and are permanently ‘out’ of the anus. They can cause a lot of discomfort during sitting down or walking as they rub against each other or the buttocks.
The only treatment is a conventional haemorrhoidectomy (Milligan-Morgan or Ferguson method).
The rubber band ligation is a clinic procedure Piles surgery in Singapore that takes about 2 min and involves very little discomfort to the patient. The rubber bands usually dislodge after a few days or up to 2 weeks without the patient being aware. The rubber bands cut off the blood supply and hence shrinks the haemorrhoids.
A stapled haemorrhoidectomy involves using a circular surgical stapler that is placed within the upper anus. The stapler will then excise/remove a 1cm ring of the anal lining that contains the blood vessels supplying the haemorrhoids, followed by a row of staples to re-unite the edges of the cut anal lining. The two common systems available on the market is the PROXIMATE® PPH system by Ethicon and EEA™ system by Medtronic.
Both procedures utilise the same surgical principle of locating the feeding hemorrhoidal vessels with a specially designed ultrasound probe followed by surgical stitching in the anus to close off the vessels without any wounds.
The THD® Doppler Surgery system and the HALO™ system are the commonest systems on the market. It is important to note that this form of Haemorrhoids surgery in Singapore is more suitable for patients with predominantly bleeding symptoms with minimal prolapse of haemorrhoids.
The Conventional haemorrhoidectomy is the gold standard by which all new hemorrhoidal surgery procedures are compared against. The conventional haemorrhoidectomy method has been in use for over fifty years and is the only treatment option available for large third-degree and fourth-degree hemorrhoids.
The conventional haemorrhoidectomy involves a surgical excision/’cutting out’ of the haemorrhoids with diathermy. The wound can then be left open to heal on its own (Milligan-Morgan method) or stitched up (Ferguson method). Each Piles surgery in Singapore method has its advantages and disadvantages.
These are variants of the conventional haemorrhoidectomy method, with the LigaSure™ surgical sealer or Harmonic® ultrasonic scalpel used in place of the electrical diathermy. The main advantage is that of a lower post-op bleeding risk.
It is important to discuss with your Haemorrhoids surgeon in detail the best treatment option for your condition.
This will depend on how severe your symptoms are. Fortunately, simple lifestyle changes can help relieve mild symptoms within a week.
No. However, symptoms of haemorrhoids can get worse with various forms of exercise.
Both external and internal haemorrhoids can become thrombosed (a blood clot forms inside the vein).
Thrombosed haemorrhoids aren't dangerous, but can cause severe pain and inflammation, and might burst if it becomes too full of blood.
No. Doing so can lead to painful complications. Additionally, many conditions (eg. skin tags) can be easily confused for a haemorrhoid.
Always consult your doctor for definitive diagnosis and treatment.
- Eat more fibre
- Drink more water
- Exercise regularly
- Do not sit and strain on the toilet for a long time
- Don’t force a bowel movement when you don’t need to