Hemorrhoids aka Piles

Hemorrhoids are quite common in Singapore with 1 in 20 people or 5% getting it in their adult hood. According to the Division of Surgical Oncology and the National cancer centre in Singapore, this can go up to one in three people in Singapore.

The main cause is the build up of pressure in your lower rectum. Due to the increased pressure, the veins around the anus stretch, swell, bulge and become enlarged causing a hemorrhoid. The most common reasons this occurs:

• Straining during bowel movement
• Obesity
• Pregnancy
• Frequent bowel movements
• Cancer of the rectum
• Constipation

Symptoms vary depending what kind of hemorrhoid you get. There are three kinds: External Internal and Thrombosed:

External.

These appear outside and around the skin of your anus, very visible. Symptoms include:

• Bleeding
• Pain
• Swelling around the anus

Internal.

These are not as visible as the external ones and you might not feel them most of the time. The only situation you might feel it is when passing motion or straining that area. Symptoms include:

• Bleeding during bowel movement. This will appear as bright red blood either on the shit or when wiping with a tissue.
• Sometimes, you can see a hemorrhoid protrude out of the anus. This means your hemorrhoid has prolapsed which can result in pain and discomfort.

Thrombosed.

This is a hemorrhoid that has no blood flow due to blood clots. These can be quite painful and are a more serious version of the external hemorrhoids as the present usually outside the anus. They look like a single or cauliflower protrusion. Symptoms include

• Severe pain
• Lump near your anus
• Bleeding
• inflammation

We look for the symptoms by physical examination, proctoscopy or Colonoscopy. Traditionally, there are 4 degrees to grade hemorrhoids:

1st degree: Bleeding only when shitting but do not prolapse (bulging outward from the anus).

2nd degree: Lump appears but retract by itself. Signalling mildly inflamed, thin-walled veins or arterioles.

3rd degree: Lump which has to be pushed back in digitally

4th degree: Total prolapse which cannot be reduced

1st degree hemorrhoids can be treated by eating high-fiber foods, using topical over the counter hemorrhoid cream or soaking the anus in a warm water bath for 10-15mins.

Medication

Certain medication and creams like proctosedyl, suppositories, Daflon. These products contain chemicals such as hydrocortisone and lidocaine which are pain and itch relievers. Please see a doctor or one of our specialists for better advice on a medical treatment plan. Medication does not work as well if piles are severe or in later stages

Minimally invasive procedure

Injection (sclerotherapy) is a treatment to reduce the hemorrhoid tissue by injecting a chemical solution. This might be recommended for small internal hemorrhoids.

Rubber banding or rubber band ligation

The doctor will place a rubber band at the base of the hemorrhoid to cut off blood circulation which slowly becomes smaller and falls off within a week. Please note that bleeding and discomfort is to be expected, however, no major complications will occur.

Surgical options for treatment include:

Excision hemorrhoidectomy

This is good for solitary external piles. It can be used for multiple piles but pain can be quite considerable. The surgeon just excises the solitary pile with diathermy. There are various techniques to accomplish this. The procedure can be done under local or general anaesthesia

Laser ablation

A laser probe is inserted into the hemorrhoid. The heat produced coagulates the internal parts of the pile which leads to it shrinking and resolution.

Transanal Endoscopic ligation

The vessel supplying the piles are located by ultrasound and then ligated. This leads to shrinkage and resolution of the piles. It is good for second and third degree piles but not as effective for severe 3rd degree and 4th degree piles.

Stapled hemorrhoidectomy

This is more commonly reserved for severe 3rd degree and 4th degree piles. A stapler is inserted into the anus, closed and fired. This resects a circumferential ring of tissue which includes most of the hemorrhoidal tissue. In most cases, pain is minimal and only lasts a few days.

Please consult one of our specialists to see which treatment is appropriate. Contact us here.

Hemorrhoid complications are rare but there are certain indications which will tell you things are getting worse.

Anaemia

If there is chronic blood loss from the hemorrhoid, you could show symptoms of anemia like fatigue or weakness. Which means there is a lack of oxygen to your cells.

Strangulated hemorrhoid

This can be quite painful as the blood supply to the hemorrhoid is cut off.

Blood Clot

This is a thrombosed hemorrhoid which means a clot has formed within the hemorrhoid. Not life threatening but very painful.

The main idea is to not strain your anus by having soft stool. Prevention of hemorrhoids can be done by drinking a lot of water, eating fruits after dinner which have fibre, do not sit too long in the toilet, avoid constipation and do not strain

Generally, Hemorrhoids is not life threatening but can be severely painful. It follow the various degrees of progression from 1st degree to 4th degree. Very late stage progression includes:

• Bleeding which has the potential to cause anemia
• Thrombosed Hemorrhoids can cause pain
• Prolapsed Hemorrhoids, where it becomes huge and presents as a cauliflower protrusion outside the anus
• The symptoms can hide cancer of the rectum
• Effects lifestyle as there is severe pain while passing motion and sitting

Most appointments concerning Hemorrhoids would require a consult to determine the degree of severity. The specialist would then recommend a treatment plan. If you are experiencing symptoms of Hemorrhoids, please make an appointment with us.