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A pile of trouble

One in three Singaporeans suffers from piles. Simple lifestyle changes can go a long way towards preventing it from getting out of hand.

Haemorrhoids, also known as piles, are symptomatic arteriovenous vessels in the anus and lower rectum. Haemorrhoids are involved in fine-tuning anal continence, as they swell up to strengthen the anal musculature to control leakage of intestinal contents. These anorectal vascular tissues are found in the anal canal of every human body, including foetuses and babies.

Haemorrhoids can be classified into two categories: internal and external. Internal haemorrhoids are located inside the rectum and are usually not visible or felt. Straining or irritation during bowel movement can damage a haemorrhoid’s delicate surface and result in bleeding. Straining may also push an internal haemorrhoid through the anal opening, leading to a prolapsed haemorrhoid.

External haemorrhoids are positioned under the skin around the anus. Itching or bleeding occurs when these piles are irritated. The blood pool may also form a clot that causes severe pain, swelling and inflammation.

Piles are a common ailment and the incidence rate is particularly high in Singapore so much so that our island has half-jokingly been called “the piles capital of the world”. This can be attributed to the prevalent practice of exerting force when passing motion.

Most people suffer from piles at some point in their life, but it is usually a temporary problem. However, symptoms like bleeding may indicate a life-threatening condition such as colorectal cancer. Therefore, it is important to receive a definitive diagnosis by a doctor.

Causes and risk factors

Ageing Older people are prone to piles due to wear and tear, as well as the degeneration of rectum and anus tissues.

Pregnancy Symptomatic haemorrhoids are common during pregnancy as the expanding uterus pushes against and puts pressure on the anal cushions.

Sitting on the toilet bowl for extended periods Reading and playing mobile games while sitting on the toilet bowl prolongs the time spent in the toilet and results in straining and symptomatic haemorrhoids.

Squatting Avoid using squat toilets as the squatting position is injurious to piles.

Constipation Constipation is commonly caused by overconsumption of fruits, vegetables and other foods containing high dietary fibre that are indigestible by the body. Contrary to popular belief, dietary fibre does not improve constipation but instead increases faecal bulk and volume, which aggravate the haemorrhoids and cause excessive straining when passing motion.

Signs and symptoms

  • Painless bleeding during bowel movements
  • Itching or irritation in the anal region
  • Swelling around the anus
  • A sensitive or painful lump near the anus
  • Leakage of faeces


Health and lifestyle changes that may ease or prevent haemorrhoid inflammation:

  • Early problems from piles can be avoided by not letting yourself get constipated
  • Avoid spending excessive time sitting on the toilet bowl to read or play mobile games
  • Reduce intake of high dietary fibre and cereals


Treatment is not usually needed for piles, unless they are causing suffering. They are treated in different ways depending on size and condition:

  • Small piles can be ligated or injected at a clinic
  • Prolapsed piles that bleed can be treated by avoiding the use of abrasive toilet paper and cleansing with water instead
  • Large problematic piles may need surgery. Compared to old methods of excisional surgery, which is excruciating and results in terrible pain when passing motion after surgery, new procedures such as stapled haemorrhoidectomy are much less painful but just as or even more effective for patients with large piles and frequent symptoms.