Learn about symptoms and causes of piles, self-help treatment options, medication and when to seek medical help.

What are piles?

Piles, also known as haemorrhoids (hemorrhoids), is a common condition. They are abnormal swollen blood vessels and tissues in the rectum or anus. People with piles may experience no symptoms or mild symptoms which disappear after a few days. Some others may develop symptoms such as bleeding, pain and discomfort around the anus.

There are two types of piles- internal and external. Internal piles are found within the anus but may hang out of the anus temporarily or permanently. External piles are found outside the anus and may have blood clots inside them. Small internal piles do not usually cause pain as there are no pain-sensitive nerves where they are located. 

What are the possible causes of this condition?

Piles are generally due to an increased pressure in the blood vessels within and around the anus. Some of these causes include: 

• Persistent or prolonged straining due to long-term constipation or diarrhoea
• Spending long periods of time on the toilet bowl
• Sitting down or standing for long periods of time
• Regularly lifting heavy objects
• Being overweight or obese
• Pregnancy
• Having a family history of piles
• A low fibre diet
• Not having enough water or fluids
• Ageing 

What are the symptoms of piles?

The symptoms of this condition can include the following:

• Bright red blood (bleeding) on toilet paper or in the toilet bowl after passing motion
• Soreness, discomfort, or pain around the anus
• Itch around the anus
• Feeling of incomplete bowel movement or fullness in the anus
• Mucus discharge after passing motion
• External piles may be felt as lumps around the anus
• Internal piles may hang out of the anus during bowel motion, and disappear back inside the anus on its own, or need to be physically pushed back into the anus. Some internal piles hang out of the anus permanently and cannot be pushed back into the anus

What can I do to treat piles?

Piles can be treated in the following ways and you can approach your pharmacist to get the following medications. 

• Topical anti-inflammatory to bring down swelling, pain, or itch (e.g. Hydrocortisone cream)
• Local anaesthetics to numb pain and itch (e.g. Lidocaine or Lignocaine cream or ointment)
• Paraffin-based ointment to soothe itch
• Witch hazel-based gel to shrink swollen blood vessels 
• Diosmin and Hesperidin tablets to shrink swollen blood vessels
• Oral pain relievers (e.g. Paracetamol tablets or liquids)
• Medications to relieve constipation:
  • Bisacodyl Tablets or Suppositories
  • Fleet Enema
  • Glycerin Suppository and Gel
  • Ispaghula Husk
  • Lactulose Syrup
  • Senna Tablets
  • Macrogol powder

When do I need to see a doctor?

Although piles can be treated without a doctor’s consultation, there are times where the condition might be more serious. 

If your condition does not get better in 7 days or gets worse, you should see a doctor. You should also see a doctor if you experience any of the following:

• Unexplained loss of appetite and weight
• Bleeding at times other than passing motion
• Changes in bowel habits or movements
• Changes in colour and shape of stools
• Hard lump(s) at the anus

Some symptoms of piles may be similar to that of colon cancer.

What else can I do to manage this condition?

Other than using medications to treat the condition, piles can also be managed by the following methods:

• Clean anal area gently and do not rub after passing motion
• Soak anal area in warm water to soothe symptoms (e.g. in a bathtub or a sitz bath)
• Apply a cool compress to the anal area
• Wear loose, soft cotton underwear to minimize discomfort and stop moisture build-up

The following are some suggestions to prevent piles from happening again:

• Prevent constipation in the following ways such as:
  • Gradually increase intake of high-fibre food such as vegetables and fruits
  • Increase water and fluid intake (if not fluid restricted)
  • Exercise regularly 
  • Do not ignore the urge to pass motion
• Avoid sitting down or standing for long periods of time
• Avoid spending long periods of time on the toilet bowl (e.g. like using your handphone)
• If overweight or obese, exercise regularly and adopt a healthy diet to lose weight

Disclaimers

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

The content above is solely for informational purposes only and is not intended as a substitute for the advice provided by your physician, pharmacist or other healthcare professional. You should not use the information for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. Always speak with your physician, pharmacist or other healthcare professional before taking any medication or supplement, or adopting any treatment for a health problem.