Piles / Haemorrhoids


Haemorrhoids are engorged blood vessels covered by the lining of anal canal that may slide down or prolapse, enlarge and bleed.




It is important to understand the differences between the following structures:

  1. Anal skin tags
    Folds of skin arising from the anal verge. They are usually the end result of thrombosed (clotted) external haemorrhoids.
  2. External haemorrhoids
    Dilated blood vessels that are easily seen at the anal verge. They are usually bluish in appearance.
  3. Internal haemorrhoids
    They are the haemorrhoids that can cause prolapse, bleeding, swelling, leaking mucus or cause itchiness in the anal region. The operation haemorrhoidectomy aims to treat this haemorrhoid.


  1. Bleeding
    Typically, this is bright red, painless and occurs at the end of defaecation. The bleeding is often described as blood on the paper, dripping or spraying into the toilet bowl. The bleeding may also be “hidden”, i.e. tested positive on stool test (Faecal Occult Blood Test) but not visible on inspection.
    It is very important not to assume all bleeding are due to haemorrhoids. Bowel cancer can give rise to bleeding as the only symptom.
    Therefore, it is essential to exclude other causes of bleeding first before blaming haemorrhoids. Investigations include flexible sigmoidoscopy/colonoscopy.
  2. Anaemia
    With prolonged history of bleeding, the patient may become anaemic. The recovery from anaemia after haemorrhoidectomy is usually rapid.
  3. Prolapse
    This usually occurs during straining at bowel opening. In the majority of situations, the haemorrhoids reduce by themselves. Occasionally, they need to be pushed back in. When the haemorrhoids become very large, they are not reducible and they stay out of the anus all the time.
  4. Pain
    Pain is not a symptom of uncomplicated haemorrhoid. It may indicate other diseases such as an abscess or anal tear (anal fissure).
    Painful haemorrhoids are uncommon and they are usually a result of thrombosis (clotting) or strangulation (prolapse leading to obstruction of blood flow in and out of haemorrhoids).
  5. Itchiness (pruritus ani)
    This is related to mucous leakage which can lead to itchiness and burning discomfort in the skin around the anus.