Have you ever noticed discomfort, itching, or bleeding during bowel movements and wondered if it may be piles? Piles, also known as haemorrhoids, affect many adults and are often linked to factors such as constipation, long hours of sitting, or pregnancy. While the condition can be uncomfortable, it’s also very treatable, especially when detected early. In this article, we explore the four stages of piles, how they progress, and when you should seek medical attention. Keep reading to learn more.

What Are Piles?

Piles, also known as haemorrhoids, are swollen veins that form in or around the anus and rectum when pressure builds up in the area. This pressure causes the veins to stretch and swell, sometimes leading to inflammation, irritation, or bleeding.

There are two main types of piles:

Internal Piles: Formed inside the rectum, internal piles are usually painless in the early stages, though they may cause bleeding during bowel movements or prolapse in advanced cases.
External Piles: These develop under the skin around the anus and are more likely to cause pain, itching, or swelling.

The 4 Stages of Piles

Piles can range from mild discomfort to more severe, prolapsed tissue that requires medical care. Doctors classify them into four stages based on how much the swollen tissue protrudes and whether it returns to its original position naturally.

Stage 1: Mild Piles

At this stage, the piles are small and remain inside the rectum. They may cause light bleeding during bowel movements, often seen as bright red streaks on toilet paper or in the toilet bowl. Discomfort is usually minimal, and symptoms often improve with simple changes such as eating more fibre-rich foods, drinking enough water, and avoiding straining when using the toilet.

Stage 2: Piles That Prolapse and Retract

Here, the swollen tissue may protrude from the anus during bowel movements but slips back inside on its own afterwards. You might notice mild bleeding, itching, or a feeling of incomplete relief after passing stools. If symptoms persist, your doctor may recommend a minimally invasive treatment such as rubber band ligation, which helps shrink the affected veins.

Stage 3: Piles That Require Manual Reduction

At this point, the piles protrude during bowel movements and don’t retract naturally. They may even need to be gently pushed back into the rectum. Persistent pain, swelling, and irritation are common at this stage. Procedures such as ultrasound-guided haemorrhoidal artery ligation or Haemorrhoid Energy Therapy (HET) can effectively reduce symptoms and prevent further prolapse.

Stage 4: Severe Prolapsed Piles

This is the most advanced stage, where the piles remain permanently outside the anus and cannot be pushed back in. They can be painful and may cause bleeding, blood clots, or even infection. Surgery is often the best option at this point to remove or reduce the swollen tissue and prevent future complications. Without proper management, stage 4 piles can lead to persistent bleeding or recurring infections.

When to Seek Medical Attention

Piles can sometimes resemble other conditions such as anal fissures, infections, or, in rare instances, colorectal cancer. A medical evaluation helps confirm the cause and ensures the right treatment.

You should see a specialist if you experience:

Frequent or heavy bleeding during or after bowel movements
Persistent pain, swelling, or itching around the anus
Lumps that remain outside the anus even after cleaning or moving around
Noticeable changes in your stool, such as prolonged constipation or unusually narrow stools

Treatment Options at Our Piles Clinic

At HKS Piles Clinic, patients receive care tailored to their condition’s stage and severity. Treatments range from conservative measures to advanced surgical options, depending on your symptoms and lifestyle needs.

Lifestyle Management: For early-stage piles, simple adjustments like increasing fibre intake, drinking more water, and avoiding long periods on the toilet can help ease symptoms.
Banding (Rubber Band Ligation): A small band is placed around the base of the haemorrhoid to block its blood supply, causing it to dry out and fall off naturally within a few days.
Sclerotherapy: This involves injecting a special solution into the haemorrhoid to make it shrink and eventually be reabsorbed by the body.
Ultrasound-Guided Haemorrhoidal Artery Ligation: Using ultrasound imaging, the doctor locates and ties off the arteries feeding the haemorrhoids, reducing their size while preserving surrounding tissue.
Haemorrhoid Energy Transfer (HET): Controlled heat is applied to internal haemorrhoids to shrink them and relieve discomfort, making it suitable for mild to moderate cases.
Laser Piles Surgery: A precise laser removes or reduces haemorrhoidal tissue with minimal bleeding and quicker healing.
Haemorrhoidectomy: For severe or recurrent cases, surgical removal of the enlarged veins offers the most reliable long-term solution.

The best treatment for you depends on a detailed medical evaluation. If you’ve been experiencing ongoing discomfort, pain, or bleeding, it may be time to consult a piles specialist. Schedule an appointment today and receive a personalised treatment plan that addresses your specific symptoms and supports 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.