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    Singapore General Hospital
    Contributed by Centre for Digestive and Liver Diseases (CDLD)


    Low fibre diet can cause piles.Haemorrhoids, commonly known as piles, are abnormally engorged and swollen blood vessels in the anus and lower rectum.


    Multiple factors can result in a person developing symptomatic piles and these are generally associated with any condition that can cause an increase in the intra-abdominal pressure.

    • Persistent straining during bowel movement and sitting on the toilet for a long period of time.
    • Chronic constipation and diarrhoea.
    • Pregnancy.
    • Low fibre diet.
    • Obesity.
    • Intra-abdominal or pelvic tumour.


    • Bleeding from the anus on defecation or straining, usually bright red in colour, due to trauma on the haemorrhoids during defecation.
    • Sensation of prolapse of the haemorrhoids through the anus during defecation.
    • Presence of lump at the anus, secondary to thrombosis in external piles or prolapsed internal piles which cannot be pushed back into the anus.
    • Pain over the anus during defecation.
    • Itch in the anal canal. This can be due to the presence of stool and constant moisture in the anal canal.


    Diagnosis of haemorrhoids requires a bedside proctoscopy, insertion of a short, straight, hollow tube after lubrication into the anus. The obturator is removed and allows visualisation of the interior of the lower rectum and anal canal.

    Colonoscopy is sometimes performed to exclude other conditions.


    1. Treatment of haemorrhoids depends on the severity of symptoms. Simple preventive measures include adequate fibre and water intake to allow regular bowel movement without straining.
    2. Oral medications and topical suppositories are used for treatment of small bleeding piles.
    3. Outpatient rubber band ligation is effective for moderate-sized bleeding piles and prolapsing internal piles.
    4. Haemorrhoidectomy is surgery to remove excessive tissue causing bleeding and protrusion not amenable to conservative management. It is the best method for the permanent removal of large, prolapsed haemorrhoids. This can be performed in the conventional manner, or through stapled haemorrhoidectomy.
    5. Transanal Haemorrhoidal Dearterialisation (THD) is a procedure involves using an ultrasound to locate the problematic blood vessels and stitching the piles.
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