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Haemorrhoids / Piles

Female Piles Surgery

What are Haemorrhoids /Piles?
By Dr. Tan Wah Siew
Haemorrhoids or piles are abnormally enlarged anal cushions

While these anal cushions are a normal part of everyone's anatomy, they can become problematic when the blood vessels within them become engorged, leading to bleeding or prolapse during defecation.

Haemorrhoids are a common condition in Singapore and are linked to factors like prolonged sitting, obesity, and chronic straining during bowel movements. Treatment options depend on the severity of the condition and may range from lifestyle changes to medical procedures.

What Are Possible Causes of Piles (Haemorrhoids)?

Haemorrhoids can stem from several factors, including:

  • Chronic Constipation – Hard stools and straining increase pressure in the anal and rectal veins.
  • Excessive Straining During Bowel Movements – This raises pressure in rectal blood vessels, causing swelling.
  • Pregnancy – Hormonal changes and the expanding uterus add pressure to pelvic blood vessels.
  • Obesity – Extra abdominal weight compresses rectal veins, causing them to swell.

What Are Common Signs & Symptoms of Piles?

Individuals with haemorrhoids may experience a variety of symptoms, such as:

  • Rectal Bleeding
  • Itching and Discomfort
  • Pain or Discomfort During Bowel Movements
  • Swelling or Lumps Around the Anus
  • Leakage of Faeces

If you are experiencing any of the above signs or symptoms, consult our haemorrhoids specialist for a timely diagnosis and the right care plan tailored to you.

How Are Piles (Haemorrhoids) Diagnosed?

Diagnosing haemorrhoids usually involves a medical history evaluation and visual examination of the anus. A digital rectal exam may be performed to check for internal haemorrhoids or any abnormalities in the rectum. In some cases, the doctor may order an endoscopy for direct visualisation of the inside of the rectum and colon.

Types of Piles (Haemorrhoids)

Internal Haemorrhoids: These form inside the rectum and are usually not visible. They tend to be painless due to the lack of pain-sensitive nerves in the rectal lining but can cause bright red bleeding during bowel movements.

Prolapsed Haemorrhoids: A more advanced form of internal haemorrhoids, these bulge out through the anal opening, especially during straining. Early-stage prolapses may retract on their own, while more severe cases may need manual reduction or medical intervention.

External Haemorrhoids: These develop under the skin around the anus where pain-sensing nerves are present. Symptoms may include itching, burning, pain, and noticeable swelling. If irritated by wiping or passing stool, they can bleed.

Thrombosed Haemorrhoids: These occur when a blood clot (thrombus) forms inside the swollen vein, leading to sudden and severe pain, swelling, and a hard lump near the anus. Thrombosed haemorrhoids may require prompt medical treatment to relieve discomfort and prevent further issues.

What Are the Different Grades of Piles (Haemorrhoids)?

Grade 1:

Blood vessels are prominent but haemorrhoids do not protrude
Piles Surgery

Grade 2:

Protruding haemorrhoids that spontaneously reduce
Piles Surgery in Singapore

Grade 3:

Protruding haemorrhoids that need to be reduced manually
Haemorrhoids Treatment Singapore

Grade 4:

Protruding haemorrhoids that can no longer be reduced manually
Haemorrhoids Surgery Singapore

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.

Non-surgical Piles (Haemorrhoids) Treatments in Singapore

Non-surgical treatments are often the first line of care for managing haemorrhoids, especially when symptoms are mild to moderate. These procedures aim to reduce discomfort, bleeding, and prolapse without the need for invasive surgery, offering quicker recovery and minimal downtime. Here are some commonly recommended options:

  • Rubber Band Ligation – This procedure involves placing a small rubber band around the base of an internal haemorrhoid to cut off its blood supply. The haemorrhoid shrinks and falls off within a few days.
  • Sclerotherapy – In this treatment, a chemical solution is injected into the haemorrhoid to shrink it. This is typically used for smaller, bleeding internal haemorrhoids.
  • Ultrasound-guided Guided Haemorrhoidal Artery Ligation – This minimally invasive technique uses ultrasound to locate and tie off blood vessels feeding haemorrhoids, causing them to shrink. Recto-anal repair (RAR) is often combined to lift prolapsed tissue.

TYPES OF HAEMORRHOID SURGERY

Haemorrhoid surgery is typically recommended when non-surgical treatments prove ineffective. This includes large, painful, or prolapsed haemorrhoids, chronic bleeding that leads to anaemia, or when symptoms severely affect quality of life.

Conventional Haemorrhoidectomy

Conventional Haemorrhoidectomy In this type of haemorrhoid surgery, the piles are removed with an electrocautery knife. Wounds typically take 4 to 6 weeks to heal fully. Strong painkillers and stool softeners are commonly prescribed to alleviate discomfort and promote a smoother recovery.

Stapled Haemorrhoidectomy

Stapled Haemorrhoidectomy A purpose-built circular stapling device is used to remove a circumferential ring of haemorrhoidal tissue and cut off its blood supply. The procedure also lifts prolapsed haemorrhoids back into place, helping restore normal alignment and reduce discomfort.

Transanal Haemorrhoidal Dearterialisation

An ultrasonic Doppler probe is used to locate the arteries supplying the haemorrhoids. These arteries are then sutured to cut off blood flow, causing the haemorrhoids to shrink and symptoms to improve over time.

Ligsasure/Harmonic Haemorrhoidectomy

Advanced technology such as vascular sealing (Ligasure) or ultrasonic devices (Harmonic) is used during piles surgery to remove haemorrhoids. These methods help minimise bleeding and often result in less postoperative pain.

Haemorrhoidectomy Singapore

Laser Haemorrhoidoplasty

A laser probe is often used to coagulate or burn the haemorrhoids. This technique minimises tissue damage and results in less post-operative pain compared to traditional surgery.

Haemorrhoidectomy Singapore

Explore haemorrhoid treatment options tailored to your needs. Arrange a consultation with Singapore piles surgeon Dr Tan Wah Siew today.

Post-surgery Care

To ensure a smooth recovery following haemorrhoid surgery, a piles specialist will recommend these care instructions:

  • Take prescribed pain medications
  • Keep the area clean and dry; use sitz baths if recommended
  • Practise good hygiene using gentle, unscented wipes
  • Eat a high-fibre diet and drink plenty of water
  • Use stool softeners or laxatives as prescribed
  • Avoid straining and gradually increase activity levels
  • Attend follow-up appointments for progress checks

Potential Complications of Piles Surgery

Though a very safe and established procedure, piles surgery still comes with some risks, including:

  • Bleeding – Mild bleeding is common; seek medical attention if bleeding is heavy or persists.
  • Infection – Infections are uncommon when proper wound care instructions are followed.
  • Pain and Discomfort – Patients often experience varying degrees of pain and discomfort. Let your doctor know if the pain is severe or persistent.
  • Anal Stenosis – Haemorrhoid surgery can sometimes result in the narrowing of the anal opening (anal stenosis), leading to difficult bowel movements.

Rest assured, serious complications are rare in the hands of a skilled piles surgeon.

FAQs About Piles (Haemorrhoids)

Not always. Mild haemorrhoids can improve with lifestyle changes. However, if you experience persistent pain, bleeding, swelling, or prolapse, seeking medical attention is advised. If you are unsure whether treatment is necessary, a consultation can help you decide your next step.

No, haemorrhoids do not lead to cancer. However, symptoms like rectal bleeding can also be signs of other conditions, including colorectal cancer. It is important to seek medical evaluation for any persistent or concerning symptoms.

Both men and women can develop piles equally. However, women may have a higher risk during pregnancy and childbirth due to hormonal changes and increased pressure.

While haemorrhoids can sometimes recur, you can lower the risk by eating a high-fibre diet, staying well-hydrated, avoiding long periods of sitting or straining on the toilet, and keeping active.

Spicy foods alone do not cause piles (haemorrhoids) directly, but they can irritate your digestive system and may make existing symptoms worse.

Singapore Female Surgeon

Piles (Haemorrhoids) Surgeon in Singapore

Dr Tan Wah Siew

Senior Consultant Colorectal Surgeon

MBBS, MMed (Surgery), FAMS, FRCSEd

Dr Tan Wah Siew is an experienced piles surgeon in Singapore and was formerly a Senior Consultant Surgeon at the Department of Colorectal Surgery, Singapore General Hospital (SGH). She was among the earliest female general surgeons in Singapore trained in robotic colorectal surgery. Dr Tan provides comprehensive care for a wide range of colorectal issues, including the treatment of piles/haemorrhoids, as well as complex surgical procedures for colorectal and pelvic cancers, ensuring personalised treatment tailored to each patient’s needs.

Female General Surgeon

Mount Elizabeth Medical Centre
#08-07, 3 Mount Elizabeth, Singapore 228510
Tel: 6454 0054 | Fax: 6764 0054 | Email: ask@surgicalassociates.sg

Gleneagles Medical Centre
#05-01, 6 Napier Road, Singapore 258499
Tel: 6471 0054 | Fax: 6271 0054

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