That pain in the butt 

By June Cheong

We all have anal cushions but we know them as haemorrhoids when we literally get that pain in the butt.

Haemorrhoids are commonly known as piles. 

"Everyone is born with anal cushions but when they get swollen, congested and bleed, they are called haemorrhoids," said Dr Jennifer Liauw, a consultant colorectal surgeon at Gleneagles Hospital.

One in three Singaporeans suffers from haemorrhoidal disease, said Professor Eu Kong Weng, the head and senior consultant surgeon in the department of colorectal surgery at Singapore General Hospital.

Patients with haemorrhoidal disease need not sit and suffer in silence though.

There is a new treatment method available here known as trans-anal haemorrhoidal dearterialisation (THD).

THD uses ultra-sound to detect the exact location of the arteries supplying blood to the haemorrhoid. The surgeon then uses the THD device to stitch up these blood vessels - cutting off blood supply to the haemorrhoid so it can no longer grow - and repositions the anal cushions in their natural site.

Singapore General Hospital is one of the first hospitals here to offer this procedure and it has already treated 120 patients since August.

Prof Eu said: "Its advantage is there's less cutting involved so there's less pain for the patient."

Depending on the severity, haemorrhoidal disease has four stages. At Stage 1, patients bleed during bowel movements but their haemorrhoids are not prolapsed.

At Stage 4, the haemorrhoids would have been permanently prolapsed and they cannot be pushed back into the anus.

Symptoms of haemorrhoidal disease range from painless bleeding during bowel movement, itching or irritation in the anal region to haemorrhoids protruding from the anus or swelling around the anus.

While anyone can develop haemorrhoids, those who suffer from constipation or strain during bowel movements as well as pregnant and post-partum women are especially prone to getting the condition, Dr Liauw said.

This is because the increased pressure in the lower rectum causes haemorrhoids by making the anal cushions enlarge and stretching the anchoring tissues.

Inadequate dietary fibre, chronic constipation, excessive straining during bowel movements and spending a long time in the toilet are other possible causes, said Dr Wong Kutt Sing, a specialist in general surgery at Raffles Hospital.

So what is considered too long a time spent in the loo?

Prof Eu said: "You should just get in and get out. Anything more than five or 10 minutes is too long."

There is a wide variety of treatment options for the condition.

Those with Stage 1 haemorrhoidal disease can take medication like Daflon and mild laxatives. Dr Wong added that lifestyle modifications such as increasing fibre intake and fluids as well as regular exercise will help too.

He said: "For small symptomatic piles, ointments and suppositories (tablets inserted into the anus) can provide relief. Sometimes, oral medication can help improve symptoms."

Larger haemorrhoids may require treatment like the injection of medical solution into the haemorrhoid to shrink it, rubber band ligation, stapled haemorrhoidectomy or THD.

In rubber band ligation, a tiny rubber band is used to tie the haemorrhoids and then they are pulled into the rectum. As for stapled haemorrhoidectomy, this involves removing a cuff of tissue above the haemorrhoids, resulting in the piles being pulled back into normal position within the anal canal.

Doctors Mind Your Body spoke to urged patients with haemorrhoids not to sit on the problem.

Dr Liauw said a much more serious condition like colon cancer has similar symptoms.

"Hence, one should never assume that a common symptom of haemorrhoids like rectal bleeding is definitely just from haemorrhoids. Proper consultation and examination is essential and then treatment options can be tailored," she said.