Have you ever noticed bleeding or discomfort after using the toilet and wondered whether it is something you should be concerned about? Many people find themselves unsure of what their symptoms actually mean, especially since these issues can feel awkward to talk about.
Piles, also known as haemorrhoids, are a common reason for such symptoms, developing when veins in the anus or rectum swell. If you have noticed these signs and are unsure whether they point to piles or something else, understanding how doctors diagnose the condition can help you feel less uncertain. Keep reading for a walkthrough of how piles are identified, what each stage of the examination involves and when it may be time to seek medical attention.
Why Accurate Diagnosis Matters
It can be tempting to assume that any form of rectal discomfort or bleeding must be caused by piles. However, similar symptoms can also occur with conditions such as inflammatory bowel disease or colorectal cancer. Treating yourself without knowing the true cause may result in delayed care, and that can affect outcomes.
An accurate diagnosis helps ensure you:
- You receive treatment that targets the actual issue
- Identify other conditions before they progress
- Reduce the risk of complications through timely care
Initial Consultation: Medical History and Symptoms
Your diagnosis often begins with a detailed conversation about your symptoms and overall health. This first meeting allows the doctor to understand what you have been experiencing, how long it has been happening and whether anything in your medical or family history might play a part.
During the assessment, you may be asked about:
- How frequent the bleeding is and its appearance
- Any itching, swelling, discomfort or mucus around the anal area
- Whether your bowel habits have changed
- A family history of colorectal conditions, such as polyps or cancer
- Your diet, lifestyle and use of medication
Physical Examination
A physical examination allows the doctor to look closely at the anal and rectal area. This helps identify visible signs of piles or other potential issues. The process is straightforward and offers valuable information on whether the piles are internal or external.
External Examination
External piles are often recognised through a simple visual check. During this process, the doctor looks for:
- Swelling or lumps around the anus
- Signs of irritation or inflammation
- Signs of thrombosis, which happens when a clot develops inside an external haemorrhoid
Digital Rectal Examination (DRE)
To evaluate internal piles, the doctor may carry out a digital rectal examination. This involves gently inserting a gloved and lubricated finger into the rectum to:
- Detect the presence of internal haemorrhoids
- Identify any unusual masses, polyps or growths
- Assess the muscle tone of the anal sphincter
The DRE is a quick and safe procedure that typically causes only mild discomfort. It provides valuable information to help guide further diagnostic steps or treatment recommendations.
Specialised Diagnostic Tests
If the initial examination shows that more information is needed, your doctor may recommend additional tests. These procedures offer a clearer view of the rectum and colon so that the root cause of your symptoms can be confirmed.
1. Proctoscopy
A proctoscopy involves inserting a small, lighted tube into the anus to inspect the rectal lining. This test allows the doctor to view internal haemorrhoids directly and assess their size, number and severity. It is often used to grade the piles and determine whether additional treatment is required.
2. Sigmoidoscopy
When symptoms point to something beyond piles, such as inflammation or polyps, a sigmoidoscopy may be suggested. This procedure uses a flexible tube with a small camera to examine the lower colon and rectum. It offers a wider view than a proctoscopy and helps identify early signs of other bowel conditions.
3. Colonoscopy
A colonoscopy may be recommended if you have unclear bleeding, ongoing symptoms or a family history of colorectal cancer. This test examines the entire colon through a flexible tube with a camera. It can detect polyps, tumours and other abnormalities, ensuring nothing significant is overlooked.
Grading of Piles
Once piles are diagnosed, they are categorised into four grades based on how far they protrude and how severe the symptoms are. This grading helps guide the most suitable treatment.
Grade 1
At this stage, piles remain inside the rectum. They may cause occasional bleeding but do not bulge outward. These cases are usually managed with changes in diet, better hydration and lifestyle adjustments.
Grade 2
These piles protrude during bowel movements but return inside on their own. You may notice itching, mild discomfort or bleeding. Treatments such as rubber band ligation or sclerotherapy are commonly used.
Grade 3
Piles in this stage come out during bowel movements and need to be pushed back in manually. You may experience pain, swelling or mucus discharge. Treatment may involve methods such as ultrasound guided artery ligation, haemorrhoid energy therapy or laser based procedures.
Grade 4
These piles remain outside permanently and cannot be pushed back in. They may cause significant pain, bleeding or clot formation. Surgery, such as laser piles surgery or haemorrhoidectomy, is usually advised.
By grading piles accurately, doctors can tailor treatment to each patient’s condition—ensuring that care is both targeted and effective while minimising discomfort and recurrence.
When to Seek Medical Advice
Piles can worsen when left unattended, so early assessment is important. If you are experiencing rectal bleeding, discomfort or persistent swelling, it is advisable to seek medical attention as soon as possible.
At Ho Kok Sun Colorectal, our piles doctor will carefully assess your condition, provide a clear diagnosis, and recommend a treatment plan tailored to your needs. Early evaluation allows for prompt care and helps prevent complications. Schedule a consultation today.
About Dr Ho Kok Sun
Dr Ho Kok Sun
Consultant Colorectal and General Surgeon
MBBS (Singapore), M Med (General Surgery) (Singapore)
FRCS (General Surgery) (Edinburgh), FAM (Singapore)
Dr Ho Kok Sun has dedicated more than a decade to the management of piles and haemorrhoids, offering both surgical and non-surgical treatment options. He is the past President of the ASEAN Society of Colorectal Surgeons and the Society of Colorectal Surgeons (Singapore), and a founding member of the Eurasian Colorectal Technologies Association.
Beyond clinical practice, Dr Ho has been actively involved in training medical students and residents and has contributed extensively to medical literature through journal publications and book chapters. He believes that every patient’s treatment should be individualised, focusing on safety, comfort and long-term results.
