Hemorrhoids (Piles)

The treatment of piles depends on the severity and the type of symptoms affecting the patient. Simple preventive measures include having a balanced diet and adequate water intake to allow regular bowel movement without straining. If this doesn't help, other treatments available include:

• Oral medications or topical suppositories. These can be used to treat small bleeding piles.
• Ligation. This rubber band treatment works effectively on internal haemorrhoids that protrude with bowel movements. A small rubber band is placed over the haemorrhoid, cutting off its blood supply. The haemorrhoid and the band fall off in a few days and the wound usually heals in a week or two. This procedure sometimes produces mild discomfort and bleeding.
• Injection. For this procedure, the doctor injects a chemical solution into the haemorrhoid, causing it to shrivel and subsequently fall off. This method is relatively painless and can also be used on bleeding haemorrhoids that don't protrude.

Piles that are not prolapsed can be ligated or injected. These are simple procedures that can be done in an outpatient clinic and do not require hospitalisation. But these procedures may not be extremely effective, and may require more than one treatment.

More definitive measures are needed for severe cases, such as when clots repeatedly form in external haemorrhoids, or Iigation fails to treat internal haemorrhoids, or when a protruding haemorrhoid cannot be reduced, or when there is persistent bleeding. Surgical techniques under general anaesthesia include:

• Haemorrhoidectomy:
  This is surgery to remove excessive tissue causing the bleeding and protrusion. It is the best method for the permanent removal of large, prolapsed haemorrhoids.
  
  Haemorrhoidectomy can be performed in the conventional manner, or through stapled haemorrhoidectomy. This is a form of surgery performed under general anaesthesia. A device is used to excise the piles internally and the internal wound is closed via a row of "staples". Compared to the conventional "open" method of haemorrhoidectomy, where there is a raw wound, stapled haemorrhoidectomy causes less discomfort and a shorter duration of pain to the patient in the immediate postoperative period. It's effective in treating large piles that protrude from the anus during defecation.
• Transanal haemorrhoidal dearterialisation (THD):
  This procedure involves using an ultrasound to locate the problematic blood vessels and stitching the piles. As methods may vary slightly from person to person, patients are advised to consult their surgeons to figure out the right treatment for them.