Haemorrhoids explained: Why they happen and what actually helps

Published on 22 March 2026

Haemorrhoids affect many people, but most can be managed without surgery. Recognising symptoms early and making simple changes can help prevent them from worsening.

At a glance

• Haemorrhoids are normal structures in the body, but become a problem when swollen.
• Most cases are painless and can be managed with simple lifestyle changes.
• Surgery is only needed when symptoms persist or become more severe.

It is one of those conditions people would rather not talk about, often out of embarrassment, until they have to.

From discomfort when sitting, to the shock of seeing blood after a bowel movement, haemorrhoids can quickly go from being a minor nuisance to a source of real anxiety. Yet despite how common they are, misconceptions about haemorrhoids remain widespread.

One of the biggest surprises? Haemorrhoids are not something you “get”. They are something you already have.

“We all have haemorrhoids,” said Adjunct Assistant Professor Lee Kai Yin, Consultant, Division of Colorectal Surgery, Department of Surgery at the National University Hospital (NUH). “These are normal blood vessels that form ‘cushions’ around the anus, and help with continence. They prevent leakage of gas or stools.”

It is only when these ‘cushions' become swollen or inflamed that most people start to notice them due to symptoms such as bleeding, discomfort, itching or pain.

Not all haemorrhoids feel the same

Haemorrhoids are broadly divided into two types: internal and external. But contrary to popular belief, they do not always cause pain. 

Internal haemorrhoids, which sit inside the rectum, often go unnoticed. Their most common symptom is bleeding during bowel movements, though they are usually painless. 

External haemorrhoids, on the other hand, are more likely to cause discomfort.

“They can be painful if they are acutely swollen due to a blood clot. These are usually external haemorrhoids,” said Adj Asst Prof Lee. “For internal haemorrhoids, they can be painful if they prolapse out.”

In other words, pain is not always the first or most important warning sign, as bleeding or a persistent lump may be just as significant. 

Why do haemorrhoids develop?

Haemorrhoids tend to worsen over time when there is repeated pressure on the veins in the rectal area. 

So, if you tend to spend long periods on the toilet, especially while using your phone, it may be worth rethinking the habit.

According to Adj Asst Prof Lee, prolonged sitting is one of several risk factors for haemorrhoids, alongside constipation, straining and pregnancy. She added, “These are risk factors that increase the likelihood of haemorrhoid formation and worsening symptoms.”

Lifestyle also plays a major role. A low-fibre diet, for instance, can lead to hard stools. Spending long periods sitting, whether at a desk or on the toilet, can further increase pressure in the area.

In Singapore, haemorrhoids are estimated to affect around 30 to 40 per cent of people. This includes both internal and external types, and typically refers to those who experience symptoms.

“They are more common in older individuals and pregnant females,” Adj Asst Prof Lee added.

Do you always need treatment?

The good news is that most haemorrhoids do not require surgery.

The first, and most important, step to managing symptoms and preventing them from worsening is adjusting daily habits.

“This includes increasing fibre and fluid intake to avoid hard stools and straining,” said Adj Asst Prof Lee.

For mild symptoms such as itching or discomfort, over-the-counter creams and oral medications can help reduce swelling and irritation.

However, there are times when it is important to seek medical advice.

Patients should see a doctor if they experience bleeding, significant pain, or symptoms that do not improve. This is particularly important for older adults, as similar symptoms can sometimes point to more serious conditions such as colorectal cancer.

If lifestyle changes and medications are not enough, doctors may consider procedural or surgical options, but these are usually reserved for more persistent or severe cases.

One of the most common non-surgical procedures is rubber band ligation, which can be done in a clinic setting.

“A small scope is inserted into the anus, and special rubber bands are applied over the enlarged internal haemorrhoids,” said Adj Asst Prof Lee.

It is a highly effective procedure, with up to 85 to 90 per cent of patients experiencing relief from their symptoms.

For more advanced cases, surgery may be recommended. Traditional haemorrhoidectomy, where the affected tissue is removed, remains one of the most effective options, although it comes with a longer recovery period. 

Newer techniques, such as laser haemorrhoidoplasty, offer an alternative.

“This involves inserting a laser fibre into the haemorrhoidal tissue to shrink the piles,” Adj Asst Prof Lee explained. “Because there is no excision involved, there is much less pain and discomfort after surgery, with faster return to daily activities.”

Can haemorrhoids come back?

Even after treatment, however, haemorrhoids can recur, especially if underlying habits do not change.

“Recurrence rates can range from 10 to 50 per cent in the long term,” Adj Asst Prof Lee noted.

The key to prevention, she emphasised, remains simple but often overlooked: diet and lifestyle.

In other words, while medical treatments can address the symptoms, lasting relief often begins with everyday choices, from what you eat to how long you sit.

And perhaps more importantly, recognising the symptoms of haemorrhoids early and making simple changes can help prevent more serious problems.

In consultation with Adjunct Assistant Professor Lee Kai Yin, Consultant, Division of Colorectal Surgery, Department of Surgery, NUH.