I hope to gather all necessary information in one post for you so you do not have to open so many tabs to understand about haemorrhoids/piles. To whoever reading this, I feel you :’)

1. What?

Haemorrhoids, also known as piles (Chinese: 痔疮), are abnormally enlarged and bulging blood vessels in and around the anus and lower rectum¹.

Two types –

(A) External
• develop near the anus
• covered by very sensitive skin
• painful swelling may occur if blood clot develops
• feels like a hard, sensitive lump
• bleeds only if it ruptures

(B) Internal
• develop within the anus beneath the lining
• painless bleeding and protrusion during bowel movements
• can be pushed back if mild

Four degrees² –

1st degree: bleed but do not prolapse
2nd degree: prolapse and retract on their own (with or without bleeding)
3rd degree: prolapse but must be pushed back in by a finger
4th degree: prolapse and cannot be pushed back in

2. Why you and me?

Common contributing factors^1,3:

• Ageing (it’s ok, we can learn how to prevent it from worsening!)
• Chronic constipation or diarrhoea (watch your diet!)
• Pregnancy (noble mums)
• Hereditary (it’s ok, we can learn how to prevent it from worsening!)
• Faulty bowel function due to overuse of laxatives (are detox products necessary?)
• Straining during bowel movements (linked to constipation)
• Spending long periods of time in toilet (stop bringing your phone everywhere…)
• Weight-lifting (your choice :))

Author’s experience:

Of course, the fact that you are reading this post means that you suspect yourself having pile(s). I want to tell you that it is alright, almost one in two will be affected by pile at some stage in their lives¹. I spotted mine when I was fifteen. It did not bother me for years although it did become slightly larger and one day in my early 20s, the second pile appeared out of nowhere. Usually they would not be affected as I pass motion but they would swell if I attempted extremely spicy food such as Mala :P. Nonetheless, slight swelling and occasional constipation did not deter me from eating what I wanted. Until things got worse.

Whenever I passed motion, the swelling of my piles worsened. I thought that the way I wiped was not clean enough so I would wash with soap BUT this action is a big NO NO⁴. (Soap can dry out and irritate piles! Water is sufficient.) Soon, I experienced itch so severe that my sleep was disrupted. Like most of us, I felt embarrassed about my condition and never wanted to visit a doctor but the itch was killing me. I scratched my head to think of something that I can apply to temporarily stop the itch. I googled and found out that tea tree oil might help!⁵ After application, I didn’t bother if it will help and rushed my ass, literally, to the nearby polyclinic. Thankfully, I could feel the itch subsiding as I made my way there.

I was anxious about the examination by the doctor as it was so embarrassing. However, I was told to lie sideways, hug my knees, and pulled down my pants to the extent that only my buttocks were exposed (so yeah our reproductive organs are safe). The examination was quick as my swelling piles were already waving their hands in the doctor’s face. I was given a tube of Proctosedyl ointment and eighteen days’ worth of Diosmin tablets.

Application of the ointment was extremely tedious and I would suggest if you end up having to do a deep application, wash with water and dry the area before inserting the cannula. The ointment (all kinds of ointment actually) is very greasy. To me, the ointment did not help much so I would not recommend you to buy ointments online to try to cure the piles on your own. After diligently eating the medication prescribed, my piles no longer swell. Unfortunately, they are still there. What can I try to do to prevent surgery?

4. How? (Home remedies VS Non-Surgical Procedures VS Surgeries)^{3, 8}

Home remedies:

a) Prevent constipation
– moderate-fibre diet (more fruits, vegetables & whole grains)
– drink plenty of water (at least 8 glasses of water per day)
– exercise regularly (at least 60 minutes of moderate-intensity physical activity per week)

b) Avoid holding off bowel movements for too long

c) Avoid sitting on the toilet for more than 5 minutes (just don’t bring your phone or book in, it is very doable)

d) Topical treatments
– Apply over-the-counter haemorrhoid cream (Effectiveness varies between people)
– Use pads containing witch hazel or numbing agent (I personally did not try this before so I am not sure about its effectiveness)
– Apply tea tree oil (as mentioned under experience)
– Insert suppository for piles (I personally did not try this before so I am not sure about its effectiveness)

e) Soak regularly in warm bath or sitz bath (Effectiveness varies between people)

NON-SURGICAL PROCEDURES:

a) sclerotherapy – a chemical is injected into the haemorrhoid to decrease its size, which will happen over several weeks

b) rubber band ligation – a method to cut off the blood supply to the haemorrhoid by tying an elastic band around it, causing it to fall off in up to 10 days

c) electrotherapy – a gentle electric current is applied to your piles to shrink them

d) infrared coagulation – an infrared light is applied to shrink the piles by cutting off blood supply

e) Oral medications – Used to treat small bleeding piles

SURGICAL TREATMENTS:

a) Haemorrhoidectomy – complete surgical removal of the piles

b) Stapled haemorrhoidopexy – removal of piles using a special stapler device (less painful than “conventional” haemorrhoidectomy)

c) Transanal haemorrhoidal dearterialisation (THD) – Using an ultrasound to locate the problematic blood vessels and stitching the piles

5. When? (to seek treatment)

Usually it is fine to live with piles as long as they do not bleed or swell severely. However, if they cause irritation, result in unbearable itch, swell continuously without showing any sign of recovery, it is highly recommended to seek a doctor’s advice whether to undergo a surgery to remove them or not.

To note, do not be overly optimistic about the surgery, piles do reappear after surgery. In fact, about 5% of the patients redeveloped piles after surgery.⁶ The success of the surgery depends heavily on the effort of patients to lead a healthier and “piles-friendly” lifestyle.

6. Where? (to seek treatment)

Specialist Services at Singapore General Hospital:
Call 6321 4377

Specialist Services at Mount Elizabeth Hospital:
Call 6250 0000 (Orchard) / 68986898 (Novena) or make an appointment online (https://www.mountelizabeth.com.sg/make-appointment)

Or you can visit the nearest polyclinic and request a referral to one of the governmental hospitals.

7. Do haemorrhoids lead to cancer?

As I was researching about piles, I came across “anal cancer”. The signs of anal cancer such as bleeding from the anus or rectum, a lump near the anus, itching or discharge from the anus, and a change in bowel habits⁷ are very similar to that of haemorrhoids. There is no way for us to tell the difference unless we go for tests, if you are worried, please see a doctor to correctly diagnose your symptoms.

On the other hand, if you are sure that the condition you have is piles instead of cancer, then good news to you, research shows that there is no relationship between piles and cancer¹. But once again, we cannot be too optimistic about anything. A healthy and active lifestyle is the way to go!

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1. Haemorrhoids. (2018, December 12). Retrieved April 19, 2021, from https://www.singhealth.com.sg/patient-care/patient-education/haemorrhoids
   
2. Tan, K., Cheong, W., Dr, Lim, F., Dr, Lieske, B., Chong, C., Lee, K., Dr, & Tan, I., Dr. (2020, October 8). Haemorrhoids or Piles. Retrieved April 20, 2021, from https://www.nuh.com.sg/Health-Information/Diseases-Conditions/Pages/Haemorrhoids-or-Piles.aspx
   
3. Ng, C. (2020, October 29). Should you get surgery for piles? Retrieved April 20, 2021, from https://www.mountelizabeth.com.sg/healthplus/article/surgery-haemorrhoids-piles-treatment
   
4. Hemorrhoids: Home remedies, lifestyle changes, and overview. (n.d.). Retrieved April 20, 2021, from https://www.medicalnewstoday.com/articles/317114#:~:text=Hemorrhoids%20are%20highly%20sensitive%2C%20and,blood%20and%20make%20bleeding%20worse.
   
5. Gotter, A. (2018, April 12). Tea Tree Oil for Hemorrhoids (1323669709 971843726 D. Wilson Dr, Ed.). Retrieved April 20, 2021, from https://www.healthline.com/health/tea-tree-oil-for-hemorrhoids#benefits
   
6. Society for Surgery of the Alimentary Tract (2008). SSAT Patient Care Guidelines: Surgical Management of Hemorrhoids. Available online: http://www.ssat.com/cgi-bin/hemorr.cgi.
   
7. Anal cancer treatment (pdq®)–patient version. (2020, April 17). Retrieved April 24, 2021, from https://www.cancer.gov/types/anal/patient/anal-treatment-pdq#:~:text=Anal%20cancer%20is%20a%20disease,a%20lump%20near%20the%20anus.
   
8. Colorectal Surgery, Singapore General Hospital. (2018, April 24). Hemorrhoids (Piles). Retrieved April 24, 2021, from https://www.kkh.com.sg/patient-care/conditions-treatments/hemorrhoids-piles/treatment