What Is Colonoscopy?
Dr Dennis Koh
Medical Director & Senior Consultant Colorectal Surgeon
MBBS (Nottingham), B Med Sci (Nottingham), MMed (Surgery), FRCS (Edinburgh), FAMS
Dr Sharon Koh
Senior Consultant Colorectal Surgeon
MBBS (Singapore), MMed (Surgery), FRCS (Edinburgh), FAMS
Dr Pauleon Tan
Senior Consultant Colorectal Surgeon
MBBS (Singapore), MMed (Surgery), FRCS (Edinburgh), FAMS
Piles (haemorrhoids) are common, affecting around one in three people in Singapore. While some cases improve with lifestyle changes or non-surgical treatment, others may require a procedure or surgery depending on the type and severity of symptoms.
At Colorectal Practice, Senior Consultant Colorectal Surgeons Dr Dennis Koh, Dr Sharon Koh and Dr Pauleon Tan provide assessment and treatment for piles, with treatment tailored to each patient's condition and symptoms.
What Are Piles?
Piles, or haemorrhoids, are vascular cushions found naturally within the anal canal that help with bowel control. They become a medical concern when they enlarge, swell or prolapse, causing symptoms such as bleeding, discomfort, itching or a lump around the anus.
Piles may be internal or external, with treatment depending on their type, severity and symptoms.
What Are the Different Types of Piles (Haemorrhoids)?
Piles can present differently depending on their location and whether complications such as prolapse or thrombosis occur.
Internal Haemorrhoids
Internal haemorrhoids develop inside the rectum and are typically painless. They may cause bright red bleeding during bowel movements and can prolapse outside the anus as they become more severe.
External Haemorrhoids
External haemorrhoids develop beneath the skin around the anus. They may cause Itching, swelling or discomfort, particularly when irritated.
Prolapsed Haemorrhoids
Prolapsed haemorrhoids are internal haemorrhoids that protrude through the anus. Depending on their severity, they may retreat on their own, need to be pushed back in or remain permanently prolapsed.
Thrombosed Haemorrhoids
A thrombosed haemorrhoid occurs when a blood clot develops within an external haemorrhoid. This can cause sudden pain, swelling and a firm lump around the anus.
What Are the Classifications of Internal Haemorrhoids?
Internal haemorrhoids are classified into four grades based on the extent of prolapse:
Grade I
Haemorrhoids are present inside the rectum but do not protrude outside the anus
Grade II
Haemorrhoids prolapse during a bowel movement but retract on their own
Grade III
Haemorrhoids prolapse and need to be manually pushed back inside
Grade IV
Haemorrhoids remain prolapsed and cannot be pushed back inside
External haemorrhoids are not classified using this grading system. Their treatment is based on factors such as symptoms, swelling and whether thrombosis is present.
How Do I Know if I Have Piles?
Symptoms of piles vary depending on their type and severity. Common signs include:
Bright red bleeding during or after a bowel movement
Pain or discomfort around the anus
Itching or irritation
A lump or swelling around the anus
Mucous discharge, particularly with prolapsed haemorrhoids
Rectal bleeding can have causes other than piles, so persistent or unexplained bleeding should be assessed by a doctor.
What Are the Causes and Risk Factors of Piles?
Piles can develop when increased pressure causes the haemorrhoidal tissue in the anal canal to swell or become displaced. Common contributing factors include:
Chronic constipation
Hard stools and repeated straining can increase pressure in the anal canal.
Prolonged straining
Regularly straining during bowel movements can contribute to the development or worsening of piles.
Pregnancy and childbirth
Increased pelvic pressure during pregnancy and straining during labour can contribute to haemorrhoids.
Prolonged sitting on the toilet
Spending extended periods on the toilet can increase pressure around the anus.
Ageing
Supporting tissues around the anal canal can weaken with age, making haemorrhoids more likely to prolapse.
How Are Piles Diagnosed?
Piles can often be diagnosed during a consultation based on your symptoms and a physical examination. Depending on your symptoms, your colorectal surgeon may perform:
Visual examination
To check for external haemorrhoids, prolapse or other abnormalities around the anus.
Digital rectal examination (DRE)
A gloved, lubricated finger is gently inserted into the rectum to check for abnormalities.
Proctoscopy or anoscopy
A small instrument is used to examine the anal canal and identify or grade internal haemorrhoids.
Further investigation
Tests such as a sigmoidoscopy or colonoscopy may be recommended if your symptoms require further evaluation or another cause of rectal bleeding needs to be excluded.
What Are Possible Complications of Piles?
While piles do not usually cause serious health problems, complications can occasionally occur. These include:
Anaemia
Haemorrhoid bleeding can lead to anaemia, a red blood cell deficiency caused by insufficient iron due to blood loss. This can cause fatigue, paleness, and shortness of breath.
Thrombosed Haemorrhoid
External haemorrhoids can sometimes develop blood clots, causing severe pain, swelling, inflammation, and the formation of a firm lump near the anus.
Strangulated Haemorrhoid
When the blood supply to an internal haemorrhoid is cut off, it becomes strangulated, which can cause severe pain, tissue damage, and infection.
Infection
In some cases, haemorrhoids can become infected, causing pain, redness, swelling, and pus drainage.
What Are Common Treatments of Piles (Haemorrhoids)?
Treatment for piles depends on their type, severity and symptoms. Mild haemorrhoids may improve with dietary and lifestyle changes, while persistent or more severe cases may require a clinic-based procedure or surgery.
Conservative Treatment
For mild piles, treatment may include:
- Increasing fibre and fluid intake to keep stools soft
- Avoiding straining during bowel movements
- Medication or suppositories to relieve symptoms where appropriate
Non-Surgical Piles Treatments
Rubber Band Ligation
A small rubber band is placed around the haemorrhoid to cut off its blood supply. The treated tissue then shrinks and falls away.
Energy Ligation of Haemorrhoidal Arteries
Energy is used to seal the blood vessels supplying the haemorrhoids, reducing their blood flow and helping them shrink.
Surgical Piles Treatments
Excisional Haemorrhoidectomy
The haemorrhoids are surgically removed. Depending on the technique used, the wound may be left open to heal or closed with stitches.
Stapled Haemorrhoidopexy
Prolapsed haemorrhoidal tissue is repositioned inside the anal canal and secured using a circular stapling device.
Ligasure Haemorrhoidectomy
A specialised energy device is used to seal blood vessels and remove haemorrhoidal tissue.
Your colorectal surgeon will recommend a treatment based on the type and grade of haemorrhoids, your symptoms and whether previous treatments have been effective.
Can Piles Be Prevented?
While piles cannot always be prevented, reducing constipation and straining may help lower the risk of developing or worsening them. You can:
Eat enough fibre to help keep stools soft and easier to pass
Stay well hydrated, particularly when increasing your fibre intake
Avoid straining during bowel movements
Avoid spending prolonged periods on the toilet
Stay physically active to support regular bowel movements
Respond to the urge to pass stool rather than delaying it
These measures may also help reduce the risk of piles recurring after treatment.
FAQs on Piles (Haemorrhoids)
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Our Piles (Haemorrhoids) Specialists
Dr Dennis Koh
Medical Director & Senior Consultant Colorectal Surgeon
MBBS (Nottingham), B Med Sci (Nottingham), MMed (Surgery), FRCS (Edinburgh), FAMS
Dr Dennis Koh is a colorectal surgeon specialising in minimally invasive and advanced endoscopic techniques. He trained in Singapore and Switzerland, where he focused on proctology and pelvic floor disorders. A Fellow of the Royal College of Surgeons of Edinburgh and the Academy of Medicine, Singapore, Dr Koh is also passionate about teaching, having served as Assistant Professor at Duke-NUS and Clinical Senior Lecturer at NUS.
About Dr Dennis Koh
Dr Sharon Koh
Senior Consultant Colorectal Surgeon
MBBS (Singapore), MMed (Surgery), FRCS (Edinburgh), FAMS
Dr Sharon Koh is a fellowship-trained colorectal surgeon with expertise in minimally invasive surgery, advanced endoscopy, and inflammatory bowel disease. She trained in advanced colorectal surgery at Cedars-Sinai Medical Center (USA) and Japan. Formerly Director of Endoscopy at Alexandra Health, she also lectures at NUS and is an active member of local and international colorectal societies like the European Society of Coloproctology.
About Dr Sharon Koh
Dr Pauleon Tan
Senior Consultant Colorectal Surgeon
MBBS (Singapore), MMed (Surgery), FRCS (Edinburgh), FAMS
Dr Pauleon Tan is an experienced colorectal surgeon focusing on minimally invasive surgery, advanced endoscopy and cancer care. After receiving the MOH Health Manpower Development Plan award, he trained in Japan, where he mastered advanced techniques to improve cancer outcomes. Dr Tan has held key roles such as Clinical Director of the Colorectal Cancer Screening Programme at KTPH and is dedicated to delivering patient-centred care.
About Dr Pauleon Tan