Singapore, piles capital of the world?

One in three people in Singapore suffers from haemorrhoids, commonly known as piles. This term refers to the enlarged a​nd bulging blood vessels in the anus. Symptoms include rectal bleeding, anal discomfort and pain, as well as swelling. There can also be anal skin tags and fissures.

Piles (haemorrhoids): Who can get it?

Piles are actually present in everyone. The normal function of these “cushioned” blood vessels is to help with liquid and gas continence. We only notice them when there is bleeding, pain, prolapse or discharge.

“In Singapore, a lot of us have been taught to exert force when we go to the bathroom. So piles are a very common problem here. My colleagues and I like to say in jest that Singapore is the piles capital of the world,” explains the ​Department of Colorectal Surgery at Singapore General Hospital (SGH), a member of the SingHealth group.

Piles are more common after the age of 30. In particular, about half the people over the age of 50 exhibit piles symptoms. Pregnant women also have a higher incidence of piles because there is excessive pressure on the anal region due to increased foetal weight and the tendency to strain during bowel movement.

Lifestyle can be a factor too. Individuals leading a sedentary lifestyle or those with bad stool habits – such as reading newspapers in the toilet – are more prone to piles. Anyone suffering from irregular bowel habits such as constipation or diarrhoea might also have a higher risk.

​Piles (haemorrhoids): An internal and external condition

Internal piles develop within the anus. The most common symptom is bright red blood covering the stools. Although bleeding is painless, internal piles can become irritated and painful when they protrude out of the anus.

External piles​ occur near the anus and are covered by very sensitive skin. Symptoms include painful swelling or a hard lump around the anus after a blood clot forms.

Treatment for piles (haemorrhoids)

Non-surgical remedies​

Stool softeners and fibre supplements may be recommended to ease bowel movement, while venotonic agents serve to reduce congestion in the piles. It is also important to drink sufficient fluids to remain hydrated.

To soothe pain, creams, ointments and cold packs can be used. A sitz bath, where one’s anus and buttocks are temporarily submerged in salt water, can provide soothing relief and reduce any swelling in prolapsed piles.


In cases where the above treatments don’t work, the patient can consider rubber band ligation. Applied just above the haemorrhoids, these elastic rings serve to cut off the blood supply and cause the piles to drop off.

In more severe cases, the haemorrhoids have to be surgically removed. The technique is stapled haemorrhoidectomy, where a specialised stapler is used instead of laser excision.

Tips to prevent piles (haemorrhoids)

To avoid piles, here are some prevention tips:

  1. Increase your fibre intake. Health Promotion Board (HPB) recommends a daily intake of 26g of fibre for men and 20g for women – this equates to two servings of fruit and two servings of vegetables per day.

  2. Drink plenty of fluids. Drink six to eight glasses of water and other liquids (not alcohol) daily.

  3. Go as soon as you feel the urge. If you wait till the urge goes away to go to the toilet, you are more likely to strain to pass stool.

  4. Avoid straining during bowel movement.

  5. Exercise regularly and maintain a healthy weight. In addition to helping prevent constipation, an active lifestyle can also help with weight loss. Excess weight can contribute to piles.

  6. Avoid long periods of sitting. Especially when sitting on the toilet bowl as it puts additional pressure on the veins in the anus. So put that phone away!

​Ref: O17

Check out other articles on digestive health:

Fatty Liver Disease: How to Reverse It

Gallstones and Gallbladder Disease: Risk Factors and Prevention

Stomach Cancer: What are the Early Signs?

IBS Food Tips: What to Eat and Avoid

Blood in Urine: When Is It Serious, When Is It Not?