WHAT ARE PILES?
Piles are actually enlarged anal cushions, which are the internal linings of the lower part of the rectum that allows us to control our bowel movement. They contain blood vessels (both arteries and veins), elastic and fibrous tissues. Anal cushions are important for everyone for healthy bowel movements but when they are enlarged and displaced downwards, they become troublesome. If completely excised, 20% of anal sphincter control can be lost.
First, let us debunk this myth: piles are not caused by sitting on hot seats! Instead, piles are caused by several other reasons like:
• Hereditary causes
• Poor bowel habit
• Chronic straining at stools
• Constipation
• Long period of sitting on the toilet bowl trying to defecate
• Pregnancy and childbirth
WHAT ARE THE SYMPTOMS OF PILES?
• Painless fresh bleeding when passing motion
• Protrusion (prolapse) which sometimes has to be pushed back
• Mucus discharge and
• Itchiness
• General discomfort
Piles are rarely painful unless complications like clotting of blood or infection occur. The symptoms stated above are not specific to piles – other conditionslike fissure (tear), blood clot (perianal haematoma), infection and inflammation of the rectum, anus or surrounding skin, fistula (opening by the side of the anus), and cancer of the anus or rectum can also mimic symptoms of piles. It is important to exclude Colorectal cancer when treating piles especially in patients over 50 years old.
PILES SURGERY
Only large prolapsed internal piles with external components and skin tags need surgery. Small internal piles are treated either by medications, injections or rubber band ligations.
For surgery, there are three options to choose from – conventional piles surgery, THD (Transanal Haemorrhoidal Dearterialisation) or Longo Stapled Haemorrhoidopexy. |
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Conventional surgery involves surgically removing piles from the sensitive anal skin outside to the interior of the anal canal. The anal skin and the lower half of the anal canal, like the lips and mouth, is a very sensitive part of the body rich in sensory nerve endings. Any cut on such surface is extremely painful especially if accompanied by inflammation and infection.
Over the years, colorectal surgeons have been trying to minimise the pain. One way is by doing meticulous surgery with diathermy, “an electric knife”, and by judicious use of painkillers, anal muscle relaxant and stool softener. Other methods include laser or ultrasound machines like Harmonic scalpel or Ligasure. These methods do not significantly reduce pain.
THD is the newest piles procedure available in Singapore. It uses a specialisedDoppler machine to locate and accurately stitch the arteries supplying the piles. Once the main blood supply is cut off the congestion in the piles is reduced and they shrink in size. Because this procedure is done inside the rectum and it does not involve any cutting, it is relatively painless.
Although THD is very good for bleeding piles, it is not so efficient in reducing prolapse or large protruding piles.
Longo Stapled Haemorrhoidopexy is another relatively “painless” surgery for piles. This method aims to restore the anatomy to normal. The theory behind this is that, since piles are due to prolapse or displacement of enlarged and engorged anal cushions from the junction of the anus and rectum, why not pull them up to their normal positions from the inside instead of cutting them out from the outside. At the same time, if the blood supply is cut down, congestion will be cleared and this can cause the piles to regress and shrink.
Longo Stapled Haemorrhoidopexy uses a staple device to cut a 2 cm circumferential sleeve of lining of the rectum to pull up the displaced piles to their normal positions, and reduce their blood supply. Patients can be discharged the same day or one day later and return to normal activity much quicker – average of four days to one week instead of two to three weeks for conventional surgery.
Dr Goh is a reputable colorectal surgeon and he is the pioneer of colorectal surgery in Singapore and the region. He established the Department of Colorectal Surgery at the Singapore General Hospital in 1989, the first such department in Singapore and the ASEAN region. He is also the founding chairman of the Society of Colorectal Surgeons (SG), as well as the inaugural chairman of the ASEAN Society of Colorectal Surgeons. |
