You may have heard your mum tell you at least once not to spend too much time straining on the toilet bowl, otherwise it would result in painful piles. Mothers know best — chronic constipation is indeed one of the causes of piles, or haemorrhoids.
Haemorrhoids are swollen blood vessels in the anus and lower rectum that become enlarged and swollen due to pressure. They are felt as small, round lumps around your anus or outside the anal canal. While they sound serious, haemorrhoids are actually very common in Singapore and occur in adults from time to time.
What are the symptoms to look out for, and is surgery necessary if you have piles? Let’s find out.
What causes piles?
Piles generally happen when the veins around your anus stretch and swell up due to increased pressure. There are a few activities that cause this extra pressure, with the most common being:
- Chronic constipation or diarrhoea
- Straining during bowel movements
- Heavy lifting
- Prolonged periods of sitting on the toilet
- Anal sex
- Family history of haemorrhoids
How do I know if I have piles?
If you have piles, you may notice:
- A hard and possibly painful lump around your anus
- Feel like your bowels are not completely emptied after passing stool
- Bright red blood on the toilet paper after passing stool
- Slimy mucus on your underwear
- Pain while you are passing motion
- An itch around your anus
Should I see a doctor if I think I have piles?
In most cases, the symptoms of piles are not serious and usually resolve in a few days. However, you should still see a doctor to determine if you have internal or external haemorrhoids and the stage of your piles. If not treated, severe piles can develop complications such as a fistula.
Internal haemorrhoids develop inside the rectum and are usually not noticeable or felt. While internal haemorrhoids rarely cause discomfort, they tend to lead to bleeding while passing stool. External haemorrhoids form under the skin and tend to be itchy and painful. They can clot and lead to thrombosed external haemorrhoids, which require immediate medical attention.
Piles is classified into four grades:
Grade I: They are small inflammations usually inside the lining of the anus that are not visible.
Grade II: They are larger than Grade I piles but are still located inside the anus. While they may be passed out during bowel movement, they will still return.
Grade III: Grade III piles are known as prolapsed haemorrhoids and appear outside the anus. You may feel them hanging from the rectum and will not retract on their own.
Grade IV: Grade IV piles are large, remain outside of the anus and require treatment.
Is surgery necessary for piles?
I usually recommend some lifestyle changes first to manage piles. This includes a change in diet to prevent constipation and keep bowel movement regular and soft. Consume more fruits and vegetables, increase your water consumption and try as much as possible to avoid caffeine. I also encourage overweight patients to lose some weight, as losing weight may help reduce the severity of piles. Exercise is also recommended as a main therapy for piles.
To soothe discomfort, I prescribe painkillers and ointments to reduce swelling and redness around the anus. If needed, I may also prescribe laxatives to help with constipation. However, do keep in mind that medication merely helps with symptoms and does not cure piles.
Only if lifestyle changes and medication fail to work will surgery be recommended. I carry out the following day procedures:
- Sclerotherapy, where a chemical is injected into the haemorrhoid to reduce its size
- Rubber band ligation, where an elastic band is tied around the haemorrhoid to cut off blood supply. As a result, the haemorrhoid falls off in about 10 days
- Electrotherapy, where a gentle electric current is applied to your piles to shrink them
- Infrared coagulation, where an infrared light is applied to cut off blood supply and shrink your piles
If your piles do not improve over time, then they have to be removed completely through surgical means. However, such a situation is rare; about 1 in 10 people will end up needing a complete removal.
How can I prevent getting piles in future?
The best way to prevent piles is to make sure your stools are soft and easily passable so you don’t have to strain in the toilet. Drink plenty of water, consume lots of fibre and don’t strain and hold your breath when passing motion, as this creates pressure in the veins in the rectum.
Although piles can be painful, they do not usually pose any health threats and can be managed accordingly.
- Mott, T., Latimer, K., & Edwards, C. (2018). Hemorrhoids: Diagnosis and Treatment Options. American family physician, 97(3), 172–179.
- Jakubauskas, M., & Poskus, T. (2020). Evaluation and Management of Hemorrhoids. Diseases of the colon and rectum, 63(4), 420–424. https://doi.org/10.1097/DCR.0000000000001642