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Haemorrhoids, also known as piles, are swollen tissue cushions located in the anus caused by enlarged or congested blood vessels. They can be mistaken for skin tags but originate from inside the anus, while skin tags develop in the skin surrounding the anus. There are two types of haemorrhoids: internal and external. Internal haemorrhoids are situated in the lower rectum, while prolapsed internal haemorrhoids protrude from the rectum and extend outward from the anus. External haemorrhoids emerge beneath the skin around the anus and can be more painful because the skin covering them can become inflamed and wear away.

Haemorrhoids or piles can cause symptoms such as an itchy anus, the feeling of needing to go to the toilet even after passing stool, bright red blood after bowel movements, mucus in underwear or on toilet paper after wiping, and lumps or pain around the anus. Causes of haemorrhoids can include constipation, prolonged straining during bowel movements, heavy lifting, and pregnancy.

Haemorrhoids commonly cause bleeding during bowel movements, and it is important to seek medical attention if this symptom persists. It is especially crucial for individuals over 40 years of age to get an accurate diagnosis through a colonoscopy, as bleeding from colon or rectal tumors can be mistaken for haemorrhoidal bleeding. If symptoms persist for a week or more, it is recommended to consult a doctor. Medical attention should also be sought if additional symptoms are present, such as a high temperature, pus leakage from the haemorrhoids, continuous bleeding, large blood clots, or severe pain.

Rubber Band Ligation

Rubber band ligation is a quick and relatively painless clinic procedure for treating haemorrhoids in Singapore. It involves placing rubber bands around the haemorrhoids to cut off their blood supply, causing them to shrink and fall off within a few days to two weeks.

Stapled Haemorrhoidectomy

Stapled haemorrhoidectomy is a surgical procedure that uses a circular stapler to remove a 1cm ring of the anal lining containing the blood vessels supplying the haemorrhoids. The edges of the cut anal lining are then stapled together. Two common systems used for this procedure are the PROXIMATE® PPH system by Ethicon and EEA™ system by Medtronic.

THD/HALO Procedures

THD (transanal haemorrhoidal dearterialisation) and HALO (haemorrhoid artery ligation operation) procedures use a specially designed ultrasound probe to locate the feeding vessels of the haemorrhoids. The vessels are then closed off with surgical stitching in the anus. These procedures are more suitable for patients with predominantly bleeding symptoms and minimal prolapse of haemorrhoids. The THD® Doppler Surgery system and the HALO™ system are commonly used in Singapore.

Conventional Haemorrhoidectomy

The Conventional haemorrhoidectomy is considered the standard against which all new hemorrhoidal surgery procedures are compared. This method has been used for over fifty years and is the only option available for large third-degree and fourth-degree hemorrhoids. The procedure involves surgically removing the haemorrhoids using diathermy, and the wound can be left to heal on its own (Milligan-Morgan method) or stitched up (Ferguson method), with each method having its own advantages and disadvantages.

Harmonic or LigaSure Haemorrhoidectomy

Variants of the conventional haemorrhoidectomy method include the Harmonic or LigaSure Haemorrhoidectomy, which use the LigaSure™ surgical sealer or Harmonic® ultrasonic scalpel instead of electrical diathermy to reduce the risk of post-operative bleeding. It is important to discuss with a haemorrhoids surgeon to determine the best treatment option for an individual’s condition.