Haemorrhoids / Piles

Female Piles Surgery

What are Haemorrhoids /Piles?

By Dr. Tan Wah Siew
Haemorrhoids or piles are abnormally enlarged anal cushions

Haemorrhoids or piles are abnormally enlarged anal cushions, that are part of the normal anatomy in everyone but become problematic when the blood vessels within become engorged and bleed or prolapse with defaecation. Causes of piles include chronic constipation, excessive straining and pregnancy.

Treatment of haemorrhoids is dependent on its grade:

Grade 1:

Blood vessels are prominent but haemorrhoids do not protrude
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Grade 2:

Protruding haemorrhoids that spontaneously reduce
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Grade 3:

Protruding haemorrhoids that need to be reduced manually
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Grade 4:

Protruding haemorrhoids that can no longer be reduced manually
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Grade 1 and 2 haemorrhoids can usually be treated by increasing intake of fibre and water, thereby improving constipation and decreasing the need to strain when defaecating. Grade 2 haemorrhoids that do not improve with these measures can be treated with rubber band ligation. Grade 3 and 4 haemorrhoids may require surgery.


Conventional Haemorrhoidectomy

Conventional Haemorrhoidectomy The piles are removed with an electrocautery knife, and wounds generally take about 4 to 6 weeks to heal completely. The wounds tend to be fairly painful as the lower anal canal and anal skin are very rich in nerve endings. As such, strong painkillers and stool softeners are usually prescribed post-operatively.

Stapled Haemorrhoidectomy

Stapled Haemorrhoidectomy A purpose built circular stapling device is used to remove a circumferential ring of haemorrhoid tissue. This method works by removal of a ring of haemorrhoids, disruption of the blood supply to the haemorrhoids as well as pulling up of the prolapsed haemorrhoids up to their usual position.

Transanal Haemorrhoidal Dearterialisation

An ultrasonic doppler probe is used to locate the arteries supplying the haemorrhoids and a stitch is then used to suture the artery, cutting off the blood supply of the haemorrhoids which then leads to shrinkage.

Ligsasure/Harmonic Haemorrhoidectomy

Removal of haemorrhoids is performed with a vascular sealing device (Ligasure) or ultrasonic device (Harmonic). Some studies have found that these methods result in significantly less immediate postoperative pain after haemorrhoidectomy.

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Laser Haemorrhoidoplasty

A laser probe is used to coagulate or burn the haemorrhoids. With only small puncture wounds, there is markedly less post-operative pain.

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