3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

Haemorrhoids

Haemorrhoids

What is a haemorrhoid?

A haemorrhoid is a swollen vein or group of veins in the region of the anus and lower rectum. While some patients may be asymptomatic to haemorrhoids, may have reported heightened discomfort and reduced quality of life as a result. While the physical aspects affiliated with haemorrhoids are evident, haemorrhoids can also greatly induce emotional distress.
There are two primary types of haemorrhoids: internal and external. Internal haemorrhoids are located inside the rectum and are usually not visible or directly painful, though they can bleed during bowel movements. External haemorrhoids appear under the skin around the anus and can be painful, especially when irritated. Moreover, when a blood clot forms in an external haemorrhoid, it becomes a thrombosed haemorrhoid. This type is particularly painful and may appear as a hard, bluish lump. Thrombosed haemorrhoids can cause significant discomfort and may require specific treatments.

Haemorrhoids

Internal haemorrhoids occur inside the rectum and are usually painless but may bleed, while external haemorrhoids form under the skin around the anus and can be painful and itchy.
In a haemorrhoid, veins in the anus and lower rectum become swollen and inflamed, which can lead to discomfort, itching, and bleeding.

What causes a haemorrhoid?

Hemorrhoids are primarily caused by an increased pressure in the pelvic and rectal veins, which leads to swelling and stretching of the vascular structures. This pressure can cause the veins to bulge and expand, and weaken their walls and the surrounding support tissues. As a result, the veins can protrude either internally within the rectum or externally around the anus, forming haemorrhoids.

This process can be exacerbated by factors such as straining during bowel movements, sitting for prolonged periods, or any condition that increases abdominal pressure.

What are the symptoms of haemorrhoids?

The symptoms of haemorrhoids vary depending on whether they are internal or external. Common symptoms include:

Bleeding:

This is often the most noticeable symptom of internal haemorrhoids. It typically appears as bright red blood on toilet paper or in the toilet bowl after a bowel movement.

Pain and discomfort:

While internal haemorrhoids are usually painless, external haemorrhoids can cause significant pain, particularly if they become thrombosed.

Itching or irritation:

The area around the anus may become itchy or irritated due to the presence of external haemorrhoids.

Swelling:

Swelling around the anus is a common symptom of external haemorrhoids.

Lumps:

A palpable lump near the anus, which may be sensitive or painful, can be a sign of an external haemorrhoid. In cases of thrombosed haemorrhoids, the lump may feel hard.

Leakage:

In some cases, haemorrhoids can cause leakage of feces, which may cause hygiene issues and discomfort.

These symptoms can fluctuate in severity and may be exacerbated by certain activities like sitting for prolonged periods or during bowel movements.
Haemorrhoids can range from being painless to quite painful, depending on their type and condition. Internal haemorrhoids are generally painless because the rectum does not have pain receptors sensitive to mild pain and pressure. However, they may cause discomfort or a sensation of fullness, especially during bowel movements, and can bleed.
External haemorrhoids, on the other hand, can be very painful, especially if they become thrombosed. A thrombosed haemorrhoid occurs when a blood clot forms, which can result in severe swelling, inflammation, and intense pain. The discomfort can be exacerbated by sitting, walking, or during bowel movements.

Are haemorrhoids painful?

Haemorrhoids can range from being painless to quite painful, depending on their type and condition. Internal haemorrhoids are generally painless because the rectum does not have pain receptors sensitive to mild pain and pressure. However, they may cause discomfort or a sensation of fullness, especially during bowel movements, and can bleed.
External haemorrhoids, on the other hand, can be very painful, especially if they become thrombosed. A thrombosed haemorrhoid occurs when a blood clot forms, which can result in severe swelling, inflammation, and intense pain. The discomfort can be exacerbated by sitting, walking, or during bowel movements.

Who is at risk of haemorrhoids in Singapore?

These groups should be mindful of the symptoms and follow preventive measures, such as dietary adjustments, regular exercise, and management of chronic bowel issues.
In Singapore, certain individuals are more susceptible to developing haemorrhoids, primarily due to conditions that elevate pressure in the veins surrounding the anus and lower rectum. These at-risk groups include:
  • Older adults: ageing can weaken the tissues that support the veins in the anus and rectum, which makes the older population of Singapore more susceptible to haemorrhoids.
  • Pregnant women: pregnancy greatly increases the risk due to the pressure of the growing fetus on the abdomen, coupled with hormonal changes that relax the veins.
  • People with chronic constipation or diarrhea: regular straining during bowel movements can lead to haemorrhoids, as can the frequent urge and pressure changes associated with chronic diarrhea.
  • Individuals who sit for long periods: those with jobs or lifestyles that involve prolonged sitting, such as office workers or drivers, may experience increased pressure on the anal region.
  • People who are obese: excess body weight can increase pelvic pressure and exacerbate the formation of haemorrhoids.
  • Those who engage in heavy lifting: regular heavy lifting can strain the lower body, including the veins around the anus and rectum.
  • Individuals with a family history of haemorrhoids: genetic factors might contribute to the susceptibility of developing haemorrhoids.
    • These risk factors increase the pressure and strain on the anus, which can cause tears in the lining, resulting in an anal fissure.
    Pregnancy is a common risk factor for haemorrhoids due to increased pelvic pressure and hormonal changes, which can lead to swollen veins in the rectal area.

    How is a haemorrhoid diagnosed?

    A haemorrhoid is usually diagnosed through a detailed medical history assessment and physical examination. Here are some of the common steps involved in diagnosing haemorrhoids:

    Medical history:

    the doctor will ask about symptoms, bowel habits, and any past issues with haemorrhoids or other conditions that might present similar symptoms.

    Physical examination:

    during the physical examination, the doctor will inspect the anal area for visible signs of external haemorrhoids, such as swelling or prolapse.

    Digital Rectal Exam (DRE):

    the doctor may perform a digital rectal exam by inserting a gloved, lubricated finger into the rectum to feel for any abnormalities and to check for internal haemorrhoids.

    Anoscopy:

    for a closer examination, a tool called an anoscope may be inserted into the rectum. This allows the doctor to see the lining of the anus and lower rectum, which helps identify any internal haemorrhoids.

    Additional tests:

    if detailed examination is needed or if there is concern about other issues like polyps, colon cancer, or colorectal cancer, further diagnostic procedures such as a sigmoidoscopy or colonoscopy may be recommended. These involve using a camera to view the inside of the colon and rectum more extensively.

    The combination of these methods usually provides sufficient information to diagnose haemorrhoids and rule out other conditions.

    What are the treatment options for haemorrhoids in Singapore?

    Treatment options for haemorrhoids vary based on the severity and type of haemorrhoids, as well as the patient’s overall health and preferences. Here’s a list of the common treatment options:

    Lifestyle changes:

    for many, managing haemorrhoids begins with lifestyle adjustments, including:
  • Increasing fibre intake to soften stools and reduce straining during bowel movements.
  • Staying hydrated to prevent constipation.
  • Regular exercise to help prevent constipation and reduce pressure on veins.
  • Avoid prolonged sitting, especially on the toilet.

    • Over-the-Counter treatments:

  • Topical creams and ointments containing hydrocortisone or witch hazel can offer relief from itching and pain.
  • Pain relievers like acetaminophen or ibuprofen can help manage discomfort.
  • Stool softeners can help reduce straining during bowel movements.

    • Home remedies:

    simple home treatments can also be effective for self management initiatives such as:
  • Warm sitz baths: sitting in warm water for 10-15 minutes a couple of times throughout the day, especially after bowel movements, can help relieve pain and swelling.
  • Ice packs: applying ice packs to the affected area can reduce swelling and numb pain.

    • Procedures:

    if haemorrhoids are persistent or severely painful, doctors may recommend procedures like:
  • Rubber band ligation: during a rubber band ligation procedure, a band is placed around the base of the haemorrhoid to cut off its blood supply, which causes it to fall off.
  • Laparoscopic surgery: this is a minimally invasive technique where the surgeon makes several small incisions and uses tiny instruments and a camera to remove tissue around the impacted vein and induce healing. This method results in quicker recovery and less postoperative pain.
  • Haemorrhoidectomy: Hemorrhoidectomy involves the complete removal of the haemorrhoid. It’s generally used for severe cases.
  • Ligasure haemorrhoidectomy: this advanced haemorrhoidectomy technique involves a device that utilises targeted bipolar electrothermal energy to precisely seal and cut the tissue during haemorrhoid removal. The blood vessels and tissues are fused, which minimises bleeding and eliminates the need for traditional sutures.
  • Harmony haemorrhoidectomy: this advanced haemorrhoidectomy technique involves a Harmonic scalpel, a device that utilises ultrasonic vibrations to seal and cut tissue during haemorrhoid removal. This reduces bleeding, pain and inflammation — ideal for delicate dissection.
    • The choice of treatment depends on the individual’s specific symptoms and medical history, and doctors prefer starting with the least invasive options before opting for surgical treatments.
    Infrared coagulation therapy involves using infrared light to heat and shrink the hemorrhoidal tissue, which effectively reduces its size and symptoms.
    If you are suffering from haemorrhoids, please schedule an appointment with CRCS Clinic for proper diagnosis and an appropriate treatment option.

    Frequently Asked Questions

    Haemorrhoids are generally not serious and are highly treatable. However, if left untreated, they can lead to complications like anemia from chronic blood loss or a strangulated haemorrhoid, where the blood supply to the haemorrhoid is cut off, which results in extreme pain and infection.

    Preventing haemorrhoids involves dietary and lifestyle changes such as increasing fiber intake, staying hydrated, exercising regularly, avoiding straining during bowel movements, and not sitting for prolonged periods. These practices help reduce the pressure on the veins in and around the anus and lower rectum.

    Haemorrhoids are quite common during pregnancy due to increased pressure in the pelvic area and hormonal changes. Managing them involves eating a high-fiber diet, drinking plenty of fluids, doing regular physical activity, and using topical treatments recommended by a healthcare provider to alleviate symptoms.

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    Colorectal Care Specialists (CRCS)

    3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510

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