WHAT YOU NEED TO Know About Piles


Piles, also known as haemorrhoids, are swollen blood vessels that develop inside the rectum (internal haemorrhoids) or under the skin surrounding the anus (external haemorrhoids). They are very common and usually result from excessive straining during bowel movements, being overweight or pregnancy.

Piles are one of the top causes of rectal and anal bleeding, and may be accompanied by pain, discomfort and an itchy feeling. They usually go away on their own, though some may require diet and lifestyle modifications, medications, or even piles surgery to treat.


Piles occur as a result of excessive pressure in the blood vessels. It is believed that repetitive straining during bowel movements result in high pressures on the blood vessels in the anus, causing it to become swollen. The wall of the blood vessel gets stretched and thinned out and therefore tends to break easily. Once this happens, bleeding occurs.

Repetitive straining also causes supporting ligaments in the blood vessel to become overstretched and lose their elasticity. When the blood vessel loses its elasticity, it descends further down the anal canal and eventually protrudes outside the anus. Once it is outside, it becomes a prolapsed hemorrhoid, which differs from external piles.

On top of the usual causes mentioned above, age can also increase one’s risks of developing piles, as the rectal and anal vessels tend to weaken and stretch with time.


There are many people with haemorrhoids without any symptoms and are not even aware that they have haemorrhoids. The symptoms also do not correspond well with the stage of the haemorrhoids. Some of the symptoms such as itching, bleeding or pain may be due to other conditions and not necessarily due to haemorrhoids. For example, bleeding may be due to colon cancer and pain may be due to anal fissures (tear).

  • Bleeding during bowel movements
  • Lump at the anus coming out during bowel movements
  • Persistent lump(s) at the anus
  • Itching in the anal area
  • Pain


They can be divided into internal or external, depending on the location. External piles develop at the outer part of the anus. It usually develops when a blood clot is formed, resulting in a painful swelling that feels like a hard, sensitive lump. Bleeding occurs only if the overlying skin ruptures. Internal piles start from the upper part of the anal canal.

Internal piles can be further divided into different degrees

This classification is based on the haemorrhoids’ appearance and level of protrusion:

First degree – The haemorrhoids are present within the anal canal, but there is no visible lump or protrusion on the outside. They are usually discovered when there is bleeding, and it is seen when the doctor puts in a proctoscope (a small scope designed to just look inside the anus).

Second degree – The haemorrhoids are bigger and bulge out the anal canal during bowel movements. However, the bulge retracts back into the canal by itself once the straining stops.

Third degree – The haemorrhoids bulge out during a bowel movement, but it stays out for a longer time before gradually retracting back into the anus. Alternatively, the patient may push it back in after bowel movement.

Fourth degree – The most advanced stage, the haemorrhoids have bulged out the anal canal and cannot be pushed back in. In this degree, the haemorrhoids may also become strangulated, in which their blood supply is cut off due to the pressure, resulting in pain.

There is usually some confusion between 3rd and 4th degree piles with the external piles. External piles develop from the outer part of the anus, while 3rd and 4th degree piles start from inside and bulge out when it is large. The haemorrhoids treatment for both types are different.

Additionally, fourth-degree piles include thrombosed haemorrhoids, which is when blood clot forms in the affected vein, cutting off blood supply and leading to pain and swelling.

Dr Ho Kok Sun is a well-established piles surgeon in Singapore specializing in the management and treatment of piles. His services range from medical to surgical procedures such as sclerotherapy and laser hemorrhoidectomy. To book a consultation with Dr Ho, call 6737-2778.

Effective & PainlessSurgical Treatment For Piles