Get to know more about piles, also known as haemorrhoids, which affects one in three people in Singapore.
 

Despite the high number of cases of haemorrhoids among our population, there are many myths surrounding the condition. Some might think that eating spicy food or sitting on a cold surface causes haemorrhoids, or that they are permanent, while others have the idea that only seniors get them. Is it true that surgery is the only way to treat piles? Changi General Hospital’s (CGH) Department of Surgery addresses these myths and other aspects of the condition.
 

The two types of haemorrhoids

What are haemorrhoids?

Haemorrhoids are abnormally swollen blood vessels near the anus. There are two common types of haemorrhoids — internal and external — that differ in location within the anal canal. Common symptoms of haemorrhoids include bleeding, prolapse (where the haemorrhoids slip out from the anus), pain, swelling and itchiness. Some symptoms may mimic those of colorectal cancer.

It is therefore important to consult a doctor for an examination before dismissing these as merely haemorrhoid-related.
 

What are the causes of haemorrhoids?

Common causes include conditions that cause a build-up of pressure within the tummy or abdomen, which may include straining during bowel movement, constipation, obesity, pregnancy and in rare instances, a growth in the pelvis or lower abdomen. Prolonged sitting on the toilet can also cause a rise in pressure of the veins near the anus, leading to haemorrhoids.

Haemorrhoids are more common in people aged 30 and above, affecting about half of seniors over 50. Pregnant women also have a higher incidence of piles because there is excessive pressure on the anal region due to increased foetal weight and the tendency to strain during bowel movement.

Lifestyle can also be a contributing factor. Individuals leading a sedentary lifestyle or those with bad stool habits — such as the prolonged sitting on the toilet because of using the phone or reading the newspapers — are more prone to haemorrhoids. Anyone suffering from irregular bowel habits such as frequent constipation or diarrhoea might also be at higher risk.

How can they be detected?

Piles are detected based on a clinical examination by a doctor after a patient presents with the above symptoms. A clinical examination may entail examination of the anus with the use of a proctoscope (short rigid tube that allows visualisation of the anus and rectum).
 

What are some treatment options?

The CGH care team will advise patients on how to manage and treat haemorrhoids based on their individual conditions. Here are some of the common treatment options.

1. Lifestyle modifications: Patients are advised to have a high-fibre diet and adequate liquid intake, and avoid straining or prolonged sitting on the toilet. Having an active lifestyle also helps!
2. Medical treatments: Stool softeners or laxatives may be prescribed for patients with constipation or for those who strain during bowel movements. Medications can also help shrink the haemorrhoids while topical suppositories can reduce the swelling and provide pain relief.
   
3. Ligation: This involves the application of an elastic band over the haemorrhoid to cut off its blood supply, effectively “killing off” the haemorrhoid. There may be some mild discomfort and small amount of bleeding in the days after the procedure. Ligation can be performed as an outpatient procedure and hospitalisation is not generally required.
   
4. Surgery: This remains the most definitive and effective treatment for haemorrhoids where the haemorrhoid is surgically removed entirely. It is typically done under general anaesthesia but spinal anaesthesia is also an option. Depending on the severity of the haemorrhoid, a trial of the first three treatment options may be carried out before going with the option of surgery.

How can one reduce the risk of piles?

• Avoid excessive straining when passing motion
  
• Avoid prolonged sitting on the toilet bowl
• Increase fibre intake and liquid intake to help with smoother bowel movements
• Maintain a healthy weight, as obesity can raise intraabdominal pressure, which can cause the vessels in the anus to enlarge

Piling on the pressure