Is It Piles or Something Else?

Rectal discomfort or bleeding can be worrying, and many people assume it must be piles, also known as haemorrhoids. This condition is indeed common and often causes soreness, itching, and mild pain around the anus. When piles are the culprit, symptoms typically improve with small lifestyle changes or topical remedies.

However, similar signs may also point to other colorectal conditions, some of which require more urgent medical attention. If you’ve been noticing ongoing discomfort, how can you tell whether piles are really to blame? Keep reading to learn more about what piles are, when symptoms may suggest something else, and when it’s time to see a doctor.

What Are Piles?

Piles occur when veins in or around the anus and rectum become swollen. They often develop from increased pressure in these veins, which can result from straining during bowel movements, long periods of sitting, chronic constipation or diarrhoea, pregnancy, or a diet lacking in fibre. Over time, these factors can make the condition more uncomfortable and persistent.

Piles can range from mild cases that cause light bleeding to more severe forms where swollen tissue protrudes from the anus. You may notice symptoms such as:

• Bleeding during bowel movements, often bright red in colour
• Itching or irritation around the anus
• Swelling or small lumps near the anal opening
• Pain or discomfort when sitting for long periods
• Prolapse, where internal piles slip outside the anus

When It Might Be Something Else

Not every case of rectal pain or bleeding stems from piles. Sometimes, these symptoms may be caused by entirely different issues that need specific treatment. Recognising these differences can help you seek the right care sooner.

Anal Fissures

Anal fissures are small tears in the lining of the anus. They usually cause sharp, stinging pain during or after a bowel movement, and you may notice a little blood on the toilet paper. Because the symptoms can mimic piles, many people confuse the two.

Colorectal Polyps or Cancer

Polyps are small growths inside the colon or rectum. While not all are cancerous, some can bleed. If you notice bleeding along with changes in your bowel habits, unexpected fatigue, or unexplained weight loss, it’s wise to see a doctor, as these could be signs of colorectal cancer.

Anal Abscesses or Fistulas

An abscess develops when an infection causes a painful swelling filled with pus near the anus. If left untreated, it may form a fistula, an abnormal passage that connects the anal canal to the skin, leading to ongoing discharge or irritation.

Inflammatory Bowel Disease (IBD)

Conditions such as Crohn’s disease and ulcerative colitis cause inflammation in the digestive tract. These may lead to diarrhoea, abdominal pain, rectal bleeding, and tiredness. Because these symptoms overlap with piles, it can be difficult to tell the difference without proper examination.

When to Seek Medical Attention

Detecting problems early allows for better symptom control and may help prevent complications. You should see a doctor promptly if you experience any of the following:

• Heavy or persistent rectal bleeding
• Changes in bowel habits lasting more than a few weeks
• Ongoing pain, swelling, or irritation that doesn’t improve
• A lump or tissue protruding from the anus that doesn’t recede
• Unexplained weight loss or fatigue, which may indicate a more serious underlying condition

Diagnosis of Piles

Accurate diagnosis is essential, as the symptoms of piles can overlap with other colorectal conditions. During a consultation, a colorectal surgeon will first review your symptoms, medical history and any relevant lifestyle factors that may contribute to your condition.

A detailed examination may include:

• Physical Examination of the Anal Area: This allows the surgeon to identify external piles, skin irritation or other visible abnormalities.
• Digital Rectal Examination: In this test, the surgeon gently inserts a gloved, lubricated finger into the rectum to check for internal piles, tenderness or lumps.
• Endoscopic Procedures: Tests such as a sigmoidoscopy or colonoscopy may be recommended to examine the rectum and colon more closely, especially when bleeding, changes in bowel habits or other warning signs are present. These procedures help rule out conditions like polyps, inflammatory bowel disease or colorectal cancer.

At our piles clinic, Dr Ho Kok Sun conducts comprehensive evaluations using evidence-based diagnostic methods to ensure an accurate diagnosis. Schedule a consultation today to find out what’s really causing your symptoms and take the first step towards lasting relief.

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.