Haemorrhoids, also known as piles, are a common issue faced by many adults. They occur when veins in the anus or lower rectum become enlarged and inflamed, often leading to discomfort, pain or bleeding. While not life-threatening, haemorrhoids can make everyday activities uncomfortable, particularly when sitting or during bowel movements.

If you’ve noticed bleeding after using the toilet or felt a persistent lump near your anus, you may be wondering whether it’s an internal or external haemorrhoid. To help you understand the difference, HKS Colorectal Surgery, a colorectal centre in Singapore, has prepared this guide. Keep reading to learn how these two types differ and the common approaches used to manage them.

What Are Haemorrhoids?

Haemorrhoids form when pressure builds up in the lower rectum, causing nearby veins to swell. According to HealthXchange, several lifestyle and physical factors can contribute to this condition. Chronic constipation or frequent straining during bowel movements is one of the most common triggers, as it increases pressure on the veins in the rectal area. Sitting on the toilet for long periods can have a similar effect, since it reduces blood flow and keeps pressure on the anus. Pregnancy also raises the likelihood of haemorrhoids, as the growing uterus presses on the pelvic veins, slowing circulation.

Diet can play a role as well. A lack of fibre makes stools harder and more difficult to pass, which again leads to straining and swelling in the rectal veins. These factors all contribute to the development of haemorrhoids, which are then classified based on their location, either internal or external.

Internal Haemorrhoids

Internal haemorrhoids form inside the rectum and are usually not visible. This area lacks pain-sensitive nerves, so they often go unnoticed until bleeding occurs during bowel movements.

Symptoms of Internal Haemorrhoids

Internal haemorrhoids are often painless at first, but as they enlarge or prolapse, certain symptoms may become noticeable. Common signs include:

Bright red blood during bowel movements
Mucus discharge from the anus
A sensation of incomplete bowel movement
Prolapsed haemorrhoids, where swollen tissue protrudes through the anus, causing discomfort or itching

External Haemorrhoids

External haemorrhoids develop under the skin surrounding the anus. Unlike internal haemorrhoids, they are often more noticeable and can cause considerable discomfort, particularly when sitting or during bowel movements.

Symptoms of External Haemorrhoids

Because they form under sensitive skin, external haemorrhoids often lead to more discomfort than internal ones. Some indicators are:

Itching and irritation around the anus
Swelling and pain, especially when sitting
A firm lump near the anal opening
Bleeding during bowel movements

In some cases, a blood clot may form within an external haemorrhoid, a condition known as a thrombosed haemorrhoid. This can cause sudden and severe pain, swelling and discolouration. Prompt medical evaluation is advised, and minor surgical removal may be recommended to relieve symptoms and prevent complications.

When to Seek Medical Attention

Although haemorrhoids are common and often improve with home care, certain signs should prompt a visit to your doctor. You should seek medical attention if you experience:

Persistent or heavy bleeding during or after bowel movements
Severe pain or swelling that interferes with daily activities
Lumps or protrusions that do not improve with over-the-counter treatments
Changes in bowel habits, such as prolonged constipation, diarrhoea, or a sensation of incomplete emptying

These symptoms can sometimes resemble other conditions, including anal fissures, infections, or, in rare cases, colorectal cancer. A professional evaluation helps ensure an accurate diagnosis and the most appropriate treatment.

Treatment Options for Haemorrhoids

The approach to treating haemorrhoids depends on their type, severity, and response to initial care. Treatments are tailored to provide relief, prevent recurrence, and maintain patient comfort.

Lifestyle and Home Measures

Mild haemorrhoids often improve with simple lifestyle adjustments that reduce strain and prevent further irritation:

Increase dietary fibre by including more fruits, vegetables, and whole grains.
Stay well hydrated to keep stools soft and easier to pass.
Avoid prolonged sitting on the toilet to reduce pressure in the rectal area.

Non-Surgical Treatments

If symptoms persist despite home care, minimally invasive procedures may be recommended. Options include:

Rubber Band Ligation (Banding): A small rubber band is placed around the base of the haemorrhoid, cutting off its blood supply so it shrinks and falls off naturally.
Sclerotherapy: A special solution is injected into the haemorrhoid, causing it to shrink and eventually be absorbed by the body.
Ultrasound-Guided Haemorrhoidal Artery Ligation: This technique reduces blood flow to the haemorrhoidal vessels, relieving swelling and discomfort.
Haemorrhoid Energy Therapy (HET): Controlled heat is applied to treat internal haemorrhoids and reduce inflammation.

Surgical Options

Advanced or recurrent haemorrhoids, particularly third- or fourth-degree cases, may require surgery when less invasive methods are ineffective. Surgical options include:

Laser Piles Surgery: A minimally invasive procedure using laser energy to shrink or remove haemorrhoidal tissue with less bleeding and faster recovery.
Conventional Haemorrhoidectomy: The surgeon removes haemorrhoids via an incision from the outer anal skin into the anal canal; usually reserved for severe or prolapsed cases.
Stapled Haemorrhoidectomy: Prolapsed tissue is repositioned into the anal canal and secured with titanium staples, often causing less pain than conventional surgery.

If you are experiencing haemorrhoid symptoms, consulting a qualified colorectal surgeon is essential for proper diagnosis and treatment. At our haemorrhoids clinic in Singapore, Dr Ho Kok Sun offers a comprehensive range of procedures to manage haemorrhoids effectively. Contact us today to schedule an appointment.

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.