Haemorrhoids, commonly known as piles, develop when the normal vascular cushions within the anal canal become enlarged or begin to prolapse. These cushions help support continence, but they can cause symptoms when their supporting tissues weaken or when repeated pressure causes them to swell.
Symptoms may include bright red rectal bleeding, itching, discomfort, swelling or tissue protruding from the anus during bowel movements. Although haemorrhoids are a common cause of these symptoms, rectal bleeding and anal lumps can also arise from other colorectal conditions.
Patients considering travelling from the Philippines to Singapore may begin with a teleconsultation with Dr Aaron Poh. During this initial review, Dr Aaron Poh can discuss your symptoms, medical history and previous investigation results before you decide whether to travel.
Haemorrhoids are classified according to where they develop and whether prolapse is present.
Internal haemorrhoids develop inside the anal canal, above an area known as the dentate line. They commonly cause painless, bright red bleeding during or after bowel movements.
Larger internal haemorrhoids may prolapse, which means the tissue protrudes through the anus. Internal haemorrhoids are commonly graded as follows:
Grade | Description |
Grade I | The haemorrhoids remain within the anal canal and do not prolapse. |
Grade II | The haemorrhoids prolapse during bowel movements but return inside without assistance. |
Grade III | The haemorrhoids prolapse and must be gently pushed back inside. |
Grade IV | The haemorrhoids remain prolapsed and cannot be pushed back inside. |
External haemorrhoids develop beneath the skin around the anus. They may cause swelling, itching, irritation or discomfort, particularly if the surrounding skin becomes inflamed.
A thrombosed external haemorrhoid occurs when a blood clot develops within an external haemorrhoid. It may appear as a firm, tender lump and can cause sudden anal pain.
Treatment depends on the severity and duration of symptoms. Some thrombosed haemorrhoids improve with conservative care, while selected patients with severe symptoms may be considered for a procedure.
Haemorrhoids are associated with increased pressure in the anal canal and weakening of the tissues supporting the haemorrhoidal cushions.
Factors that may contribute include:
Not everyone with these factors will develop symptomatic haemorrhoids. Symptoms may also recur if constipation, straining or irregular bowel habits continue after treatment.
Common symptoms include:
Internal haemorrhoids that have not prolapsed are often painless. Sudden, pronounced pain is more commonly associated with a thrombosed external haemorrhoid, an anal fissure or another anorectal condition.
Because these symptoms are not exclusive to haemorrhoids, an examination may be required to confirm their cause.
Many patients assume that rectal bleeding is automatically caused by haemorrhoids, particularly if they have experienced constipation or previously been told they have piles.
However, rectal bleeding is a symptom rather than a diagnosis.
While haemorrhoids are among the most common causes of bright red bleeding during bowel movements, similar symptoms may also occur in conditions such as:
This is particularly relevant because colorectal cancer is among the most commonly diagnosed cancers in the Philippines and across Southeast Asia. Early-stage colorectal cancer may produce symptoms that are easily mistaken for haemorrhoids, including intermittent rectal bleeding, changes in bowel habits or a sensation of incomplete bowel emptying.
Features that may warrant further evaluation include:
Because symptoms can overlap, persistent rectal bleeding should not be automatically attributed to haemorrhoids without appropriate assessment.
Diagnosis begins with a review of your symptoms and bowel habits. Dr Aaron Poh may ask about:
The assessment may include:
The skin around the anus is examined for external haemorrhoids, thrombosis, prolapse, skin tags, fissures and other visible changes.
A gloved, lubricated finger is gently inserted into the rectum to assess for tenderness, masses and other abnormalities that may not be visible externally.
A short instrument may be used to inspect the anal canal and lower rectum. This allows internal haemorrhoids to be identified and their degree of prolapse assessed.
A colonoscopy is not required for every patient with haemorrhoids. It may be recommended when:
The investigations recommended will depend on your symptoms, examination findings, age and risk factors.
Treatment depends on:
Many patients begin with dietary and bowel-habit changes. Clinic-based procedures or surgery may be considered when symptoms persist, prolapse is more pronounced or conservative treatment has not provided sufficient relief.
Initial management may include:
These measures aim to produce softer, more regular stools and reduce pressure on the haemorrhoidal tissue.
Warm sitz baths may help relieve temporary discomfort or irritation. Topical creams, ointments and suppositories may also provide short-term symptom relief.
These products do not correct prolapse or remove the haemorrhoids. Prolonged use should be discussed with a doctor, particularly when symptoms continue or rectal bleeding is present.
Rubber band ligation may be considered for selected internal haemorrhoids. A small elastic band is placed around the base of the haemorrhoidal tissue, reducing its blood supply. The treated tissue then shrinks and separates over time.
Banding is generally performed as a clinic-based procedure and does not involve surgical removal of the haemorrhoid. Some patients may require more than one treatment session.
Temporary pressure, discomfort or light bleeding can occur after the procedure. The expected recovery and symptoms requiring medical attention will be discussed beforehand.
Sclerotherapy involves injecting a solution into the haemorrhoidal tissue to promote shrinkage. It may be considered for selected internal haemorrhoids, depending on their size, symptoms and the patient’s circumstances.
Infrared coagulation applies controlled energy to the haemorrhoidal tissue to reduce its blood supply. It may be used for selected internal haemorrhoids.
The suitability of rubber band ligation, sclerotherapy or infrared coagulation depends on the type and severity of the haemorrhoids.
A haemorrhoidectomy surgically removes haemorrhoidal tissue. It may be considered for:
Haemorrhoidectomy may have a longer and more uncomfortable recovery than clinic-based procedures, but it may be appropriate when less invasive treatments are unlikely to address the extent of disease.
Stapled haemorrhoidopexy repositions prolapsing internal haemorrhoidal tissue within the anal canal and reduces its blood supply.
It is not suitable for every patient, particularly when substantial external haemorrhoidal disease is present. The potential benefits, limitations and risk of recurrence should be considered when comparing it with other surgical approaches.
Haemorrhoidal artery ligation uses sutures to reduce blood flow to the haemorrhoidal tissue. In some procedures, prolapsing tissue may also be lifted and secured within the anal canal.
Whether this technique is appropriate depends on the haemorrhoid grade, degree of prolapse and individual clinical findings.
Patients considering travelling from the Philippines may begin with a teleconsultation with Dr Aaron Poh. During this initial review, Dr Aaron Poh may discuss your symptoms, previous treatment, medical history and available investigation results before you decide whether to travel.
The Alpine Surgical Practice team can also advise which medical records to prepare, such as previous colonoscopy reports, procedure records and medication details. A physical examination may still be required in Singapore before the diagnosis, haemorrhoid grade and treatment recommendation can be confirmed.
Where practicable, consultations, investigations and treatment planning may be coordinated around your intended travel period. The duration of your stay will depend on the assessment findings and whether a procedure is recommended.
Refer to the medical document guide for further guidance.
At Alpine Surgical Practice, Dr Aaron Poh assesses whether symptoms such as rectal bleeding, discomfort or prolapse are caused by haemorrhoids or another colorectal condition.
The consultation considers your symptoms, bowel habits, previous treatments and examination findings. Depending on the diagnosis and severity of the condition, treatment may involve dietary and bowel-habit changes, clinic-based procedures or surgery.
If your symptoms persist despite self-treatment or continue to affect your daily activities, arrange a consultation for further assessment.
Dr Aaron Poh is a fully accredited General Surgeon with dual subspecialties in Colorectal Surgery and Trauma Surgery, recognised by Singapore’s Specialist Accreditation Board and Ministry of Health. He is the Medical Director of Alpine Surgical Practice, with clinics located at Mount Elizabeth Hospital, Parkway East Hospital, and Farrer Park Hospitals.
Dr Aaron Poh has extensive experience, having performed over 5,000 endoscopic procedures. He is a strong advocate for early detection through colonoscopy, particularly for individuals at risk of colorectal cancer. His expertise includes advanced endoscopic techniques such as Endoscopic Mucosal Resection (EMR) for complex polyps and colonic stenting for obstructed cancers, which help patients avoid major emergency surgery.
When surgery is required, he specialises in minimally invasive laparoscopic colorectal cancer surgery, offering patients faster recovery with less pain and scarring. In addition to cancer care, he manages a wide range of anal conditions including haemorrhoids, fistulas, fissures, and abscesses, providing comprehensive colorectal treatment.
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