Piles (Haemorrhoids) Surgery in Singapore

Haemorrhoids are swollen blood vessels in or around the anus and lower rectum. They develop when increased pressure causes the supporting tissues and blood vessels in this area to enlarge and stretch.

Common contributing factors include straining during bowel movements, chronic constipation, prolonged sitting on the toilet, pregnancy and obesity. Over time, the supporting tissues can weaken, causing the haemorrhoids to enlarge or protrude outside the anal canal.

Haemorrhoids can affect people of all ages, but certain groups may have a higher risk of developing the condition, including:

• Adults aged 45 to 65 years
• Pregnant women
• Individuals who are overweight or obese
• People with a family history of haemorrhoids
• Those with chronic constipation or diarrhoea
• Individuals who frequently perform heavy lifting
• People who spend prolonged periods sitting

Haemorrhoids develop when pressure within the veins of the rectum and anus increases. Several factors may contribute to this pressure, including:

• Excessive straining during bowel movements
• Regularly lifting heavy weights
• Chronic constipation or diarrhoea
• Pregnancy
• Obesity
• Sitting for prolonged periods
• Having a low-fibre diet

Signs and symptoms vary depending on the type and grade of piles.

Internal Haemorrhoids

Internal haemorrhoids develop inside the rectum and may not cause noticeable discomfort initially. Common symptoms include:

• Painless rectal bleeding during bowel movements
• Mucus discharge
• A feeling of incomplete bowel emptying
• Prolapse, where the haemorrhoid protrudes through the anus

When prolapsed haemorrhoids become difficult to push back inside, further treatment or surgery may be considered

External Haemorrhoids

External haemorrhoids develop beneath the skin around the anus and are often more noticeable.
Symptoms may include:

• Pain or discomfort around the anus
• Itching or irritation
• Swelling
• Rectal bleeding
• A lump near the anus

If a blood clot develops within the haemorrhoid, symptoms may become more severe and require medical attention.

Haemorrhoids can be classified into 3 main types:

• Internal Haemorrhoids

  : Internal haemorrhoids develop inside the rectum above the dentate line. They can vary in size and are often characterised by bleeding during bowel movements. However, it does not usually cause discomfort or pain unless it has prolapsed and develops a blood clot (thrombosis).

• Prolapsed Haemorrhoids

  : Prolapsed haemorrhoids are internal haemorrhoids that have already prolapsed (protruded) from the rectum. This causes pain and discomfort when sitting or during bowel movements. Piles surgery in Singapore may be recommended to remove the haemorrhoid if it bleeds a lot, and causes pain and discomfort.

• External Haemorrhoids

  : External haemorrhoids happens just under the skin around the anus. Patients diagnosed with external haemorrhoids typically experience itching and bleeding, and may also feel a firm lump near the anus. External haemorrhoids can become painful if they form a clot called a thrombus, and might then need to be assessed by a haemorrhoid surgeon.

Piles can happen both inside and outside the anus. They are divided into 4 grades based on their size and symptoms:

• Grade I

  : Enlarged internal piles that usually present with bleeding during defecation. These can be easily treated with medication.

• Grade II

  : These larger piles tend to protrude out during straining at stools but are able to spontaneously return back into the anal canal after bowel movement.

• Grade III

  : These large piles protrude during defecation causing significant bleeding and remain outside the anus. Some finger pressure may be able to push it back inside the anus.

• Grade IV

  : These piles are persistently outside the anus and the blood in these engorged vessels is usually clotted, leading to extremely painful and swollen lumps that require surgery to achieve relief.

While most piles cause minimal discomfort and often resolve on their own, several complications can still possibly occur, including:

• Anaemia: Chronic blood loss from haemorrhoids can lead to anaemia over time. This condition occurs when the body does not have enough red blood cells.
• Thrombosed Haemorrhoid: This occurs when a blood clot forms within a haemorrhoid. The haemorrhoid may appear bluish due to the clot.
• Strangulated Haemorrhoid: This is a life-threatening complication where the prolapsed internal haemorrhoid becomes trapped outside the anus, cutting off its blood supply. If not treated promptly, the haemorrhoid tissue can die and cause sepsis.

Diagnosing haemorrhoids usually begins with a discussion of your symptoms, bowel habits and medical history. As symptoms such as rectal bleeding, discomfort and itching can also occur in other colorectal conditions, a physical examination is often required to confirm the diagnosis and assess the severity of the haemorrhoids.

• Visual Inspection

  A visual examination allows the doctor to assess the area around the anus for signs of external haemorrhoids, swelling, skin tags or other abnormalities that may be contributing to your symptoms.

• Digital Rectal Examination (DRE)

  During a digital rectal examination, the doctor gently inserts a gloved and lubricated finger into the rectum to check for abnormalities within the anal canal and lower rectum. This examination may help identify internal haemorrhoids and rule out other possible causes of symptoms.

While mild haemorrhoids may respond to conservative measures, larger or more symptomatic haemorrhoids may require procedural or surgical treatment.

• Non-Surgical Treatment

  Mild haemorrhoids may improve with dietary modifications, increased fibre and fluid intake, stool softeners and medications that help relieve discomfort, itching and inflammation. These measures may also help reduce straining during bowel movements and prevent symptoms from recurring.

• Minimally Invasive Procedures

  Minimally invasive procedures may be recommended when symptoms persist despite conservative treatment but surgery is not yet required.

  • Rubber-Band Ligation

    Rubber band ligation is a commonly performed outpatient procedure used to treat internal haemorrhoids. A small rubber band is placed around the base of the haemorrhoid to cut off its blood supply. The haemorrhoid gradually shrinks and typically falls away within several days during normal bowel movements.

• Piles Surgery

  Surgery may be recommended for larger haemorrhoids, prolapsing haemorrhoids or symptoms that continue despite other forms of treatment.

  • Conventional Haemorrhoidectomy

    Conventional haemorrhoidectomy involves the surgical removal of haemorrhoidal tissue using specialised instruments that simultaneously cut tissue and control bleeding. It is commonly recommended for advanced Grade III and Grade IV haemorrhoids.

  • Stapled Haemorrhoidectomy

    Stapled haemorrhoidectomy repositions prolapsed haemorrhoidal tissue back into the anal canal while reducing its blood supply. A circular stapling device is used to remove a ring of tissue above the haemorrhoids, helping to lift them back into their normal position.

  • Trans-Anal Haemorrhoidal De-arterialization (THD)

    THD is a minimally invasive procedure that uses Doppler ultrasound guidance to identify and tie off the arteries supplying blood to the haemorrhoids. By reducing blood flow, the haemorrhoids gradually shrink over time. As no tissue is removed, postoperative discomfort is generally reduced compared to some traditional surgical techniques.

  • Laser Haemorrhoidoplasty

    Laser haemorrhoidoplasty uses laser energy to shrink haemorrhoidal tissue from within while preserving surrounding tissue. This technique may result in less tissue trauma and a shorter recovery period for suitable patients.

  • Ligsasure/Harmonic Haemorrhoidectomy

    These techniques use advanced energy devices to remove haemorrhoidal tissue while sealing blood vessels during the procedure. This may help reduce bleeding and improve surgical precision during haemorrhoid removal.

As with any surgical procedure, haemorrhoid surgery carries potential risks and complications. Your surgeon will discuss these with you before treatment.

• Bleeding

  A small amount of bleeding following surgery is common and usually settles during the recovery period. Significant bleeding is uncommon but may occasionally require medical attention.

• Infection

  Infection may develop around the surgical site, although this is relatively uncommon. Symptoms may include increasing pain, swelling, redness or discharge.

• Pain and Discomfort

  Some discomfort is expected following haemorrhoid surgery, particularly during bowel movements. Symptoms usually improve as healing progresses and can be managed with medication.

• Anal Stenosis

  Anal stenosis refers to narrowing of the anal canal due to scarring during healing. This is an uncommon complication that may require further treatment if symptoms occur.

Following your doctor's postoperative instructions can help support healing and recovery.

• Pain Management

  Pain medication may be prescribed to help manage discomfort during the recovery period. Taking medication as directed can help improve comfort during daily activities and bowel movements.

• Activity

  Light activities can usually be resumed within a few days, although strenuous exercise and heavy lifting should be avoided until advised otherwise by your doctor.

• Lifestyle Changes

  Maintaining a high-fibre diet, drinking sufficient fluids and avoiding excessive straining may help reduce the risk of recurrence.

• Follow-Up Checks

  Follow-up appointments allow your surgeon to monitor healing, assess recovery progress and address any concerns.

• Bowel Management

  Preventing constipation is an important part of recovery. Dietary adjustments, hydration and stool softeners may be recommended where appropriate.

• Hygiene

  Keeping the anal area clean and dry may help reduce irritation and support healing after treatment.

At Kam Colorectal Centre in Singapore, patients receive care from Dr Kam Ming Hian, a Senior Consultant Colorectal Surgeon with over 20 years of experience managing colorectal and anal conditions. The clinic provides comprehensive assessment and treatment for haemorrhoids, ranging from conservative management and minimally invasive procedures to surgical treatment where appropriate.

Patients benefit from personalised treatment planning, clear explanations of available options and continuity of care throughout their treatment and recovery journey.