Piles (Haemorrhoids) and Anal Fissure
About the disease & condition
Aetiology & Pathophysiology
Piles:**
- Increased pressure in the hemorrhoidal plexus due to straining during defecation, chronic constipation, pregnancy, obesity, or prolonged sitting.
- Weakening of supporting tissues with age.
Anal Fissure:**
- Trauma from the passage of hard stools, diarrhoea, or childbirth.
- Hypertonicity of the internal anal sphincter leads to reduced blood flow and impaired healing.
Symptoms & Signs
Piles:**
- Internal: Bright red rectal bleeding (on wiping or in toilet), prolapse, discomfort.
- External: Pain (if thrombosed), swelling, itching.
Anal Fissure:**
- Sharp, tearing pain during and after bowel movements, often with bright red bleeding on toilet paper.
- Visible tear on inspection; sentinel skin tag may be present.
Red flags:** Persistent bleeding, weight loss, change in bowel habits (to rule out malignancy).
Diagnosis
- Clinical history and visual inspection.**
- Digital rectal examination (avoided in acute fissure due to pain).**
- Anoscopy:** To visualise internal haemorrhoids or fissure.
- Sigmoidoscopy/colonoscopy:** If concerned about colorectal pathology (e.g., unexplained bleeding).
Management & Treatment
Conservative measures (first-line for both):**
- High-fibre diet, adequate hydration.
- Sitz baths (warm water baths) for soothing relief.
- Topical analgesics, steroids (short-term for piles), or barrier creams.
Piles-specific:**
- Rubber band ligation, sclerotherapy, and infrared coagulation for internal haemorrhoids.
- Haemorrhoidectomy for severe or thrombosed cases.
Fissure-specific:**
- Topical nitroglycerin or nifedipine (to reduce sphincter spasm and promote blood flow).
- Botulinum toxin injection or lateral internal sphincterotomy for chronic fissures.
Potential Complications
- Piles:** Thrombosis (painful external haemorrhoid), anaemia (from chronic bleeding), strangulation.
- Anal Fissure:** Chronic fissure, incontinence (rare, from surgical complications), fistula formation.
Prevention & Follow-up
Prevention:**
- Avoid straining during defecation; maintain regular bowel habits.
- High-fiber diet, exercise, weight management.
Follow-up:**
- Most cases resolve with conservative management; reassess if symptoms persist.
- Surgical follow-up as needed for procedural aftercare.
Relevant Specialities
Gastroenterology
Our Gastrosciences service diagnoses and treats conditions of the digestive system such as the oesophagus, stomach, small intestine, colon, liver, pancreas and bile ducts. Our team of gastroenterologists, hepatologists and specialist nurses use advanced, minimally invasive techniques to give precise care. POEM (Peroral Endoscopic Myotomy) treats oesophageal motility disorders, ESD to remove early tumours without open surgery, ERCP and SpyGlass for bile-duct problems, EndoVAC for closing leaks, STER for subepithelial tumours, and capsule endoscopy to image the small intestine. We also perform diagnostics and therapeutic endoscopy (OGD, colonoscopy, EUS, manometry, pH studies) and offer stenting, polypectomy, dilation, variceal therapy and biliary drainage as needed. In addition, age appropriate diagnostics and transplant-linked care are provided with dietitians and psychological support built into long-term plans.
