Conditions That May Be Mistaken for Piles

Understanding Piles and Their Common Symptoms

Piles, or haemorrhoids, develop when the veins in the lower rectum or anus become swollen or irritated. They can occur inside the rectum, known as internal piles, or under the skin around the anal opening, known as external piles. Factors such as constipation, straining during bowel movements, pregnancy, and prolonged sitting can increase pressure in this area and contribute to their development. While piles are common and often harmless, they can still cause significant discomfort depending on their size and severity.

Symptoms can vary, but many people experience itching, tenderness, swelling, or bleeding during or after passing stool. External piles may appear as small, sensitive lumps near the anus, while internal piles may cause a sense of pressure or discomfort, particularly if they prolapse. Because these features are widely recognised, it is easy to assume that any discomfort or bleeding in the anal region must be caused by piles. However, several other conditions produce similar symptoms, which is why it is helpful to understand how mix-ups can occur.

Medical Conditions That Present Like Piles

Several conditions can produce symptoms similar to piles, such as discomfort, swelling or bleeding. Because these signs overlap, it can be difficult to tell them apart without a proper examination. The following conditions are among the most commonly mistaken for haemorrhoids:

• Anal fissures
  Small tears in the lining of the anal canal that cause sharp pain during bowel movements, often accompanied by bright red bleeding. The pain is typically more intense than what most patients experience with piles.
• Anal fistulas
  Abnormal tunnels that develop between the anal canal and the surrounding skin. They may cause persistent irritation, recurrent discharge or swelling, which can resemble external piles.
• Anal skin tags
  Soft folds of excess skin near the anal opening that can be confused with external haemorrhoids. While harmless, they may lead to mild irritation or hygiene difficulties.
• Anal abscesses
  Infections that form painful collections of pus near the anus. The swelling and tenderness can mimic piles, but abscesses often progress quickly and may be accompanied by fever.
• Inflammatory bowel disease (IBD)
  Conditions such as ulcerative colitis and Crohn’s disease can lead to rectal bleeding, urgency, or discomfort. These symptoms may initially be mistaken for piles, especially during flare-ups.
• Colorectal polyps
  Growths inside the colon or rectum that can cause bleeding. Although polyps are located higher in the digestive tract, patients may assume the bleeding originates from piles.
• Early colorectal cancer
  In its early stages, colorectal cancer may cause subtle bleeding or changes in bowel habits. Because these symptoms are nonspecific, patients may attribute them to piles rather than seeking evaluation.

Because these conditions can appear so similar, relying on symptoms alone often leads to incorrect assumptions. A proper assessment is the only way to determine the true cause of discomfort and ensure that the right treatment is given.

How Colorectal Specialists Diagnose the True Cause of Symptoms

Because several conditions can appear similar to piles, an evaluation by a colorectal specialist is often needed to identify the true source of discomfort. Diagnosis usually begins with a discussion of your symptoms and medical history, followed by targeted assessments that help distinguish between piles and other conditions such as fissures, fistulas, abscesses, or inflammatory diseases.

Colorectal specialists may use a combination of the following methods:

• Physical examination
  A visual assessment of the anal area to look for external piles, fissures, swelling, skin tags, or signs of infection. This helps narrow down the possible causes before further testing is considered.
• Digital rectal examination (DRE)
  A gloved, lubricated finger is gently inserted into the rectum to feel for tenderness, internal swelling, masses, or other abnormalities. This allows the specialist to detect issues that may not be visible externally.
• Colonoscopy
  A flexible tube with a camera is used to examine the rectum and entire colon. Colonoscopy helps identify bleeding sources, polyps, inflammatory bowel disease, and early colorectal cancer—conditions that may mimic piles but require very different management.
• Imaging
  Tests such as MRI or CT scans may be used when deeper infections or complex fistula tracts are suspected. These scans provide detailed views of internal structures that cannot be assessed through physical examination alone.

These methods are not exhaustive, but they represent some of the most commonly used tools for evaluating symptoms that resemble piles. By combining clinical assessment with appropriate investigations, colorectal specialists can determine the exact cause of symptoms and recommend the most suitable treatment approach.

Expert Diagnosis and Care at Colorectal Practice

Several conditions can resemble piles, and recognising this helps ensure that symptoms are not dismissed or misinterpreted. If discomfort, bleeding, or swelling persists despite home remedies, or if symptoms recur or change over time, it may be helpful to seek an evaluation from a colorectal specialist. A proper assessment can clarify the underlying cause and guide effective treatment, offering greater peace of mind as you manage your colorectal health.

At Colorectal Practice, we offer comprehensive evaluation and care for a wide range of colorectal concerns. Our specialists take a thorough and patient-focused approach to diagnosis, ensuring that symptoms are assessed carefully and managed appropriately. Schedule a consultation to receive personalised guidance and timely attention tailored to your needs.

About Our Piles Specialists

Our team of colorectal surgeons, led by Dr Dennis Koh, provides comprehensive care for patients suffering from piles. With over 60 years of combined experience, we are highly skilled in performing advanced diagnostic and surgical treatments for haemorrhoids in Singapore. Each procedure is tailored to ensure patient comfort, accurate results and timely follow-up care.