Procedure
BUILD NOTE: this page was drafted for the refresh and has NOT yet been read by Dr Chen. Clinical content, and the medical-review byline above, must be confirmed by him before the domain cutover.
Treatment depends mainly on the grade of the piles and on how much they affect you. Not every pile needs surgery. Many people improve with changes to diet and bowel habit alone, and a clinic procedure is often enough for early-grade piles. Piles are graded from first to fourth degree, which guides the treatment suitable for you.1
| Grade | What it means | Usual first approach |
|---|---|---|
| First | Stays inside the anal canal, usually painless | Diet, fibre and fluids; banding if bleeding persists |
| Second | Comes down on passing stool, returns on its own | Banding |
| Third | Comes down and needs to be pushed back | Surgery, or banding in selected cases |
| Fourth | Stays down and cannot be pushed back | Surgery |
Before treatment begins, any bleeding needs to be accounted for. The colon above the rectum is examined as well, to rule out causes other than piles.1 Piles are common, and they can be mistaken for the cause of bleeding that has another source.
Our guide to piles (haemorrhoids) covers the condition.
For mild symptoms, Dr Chen may first suggest increasing fibre and fluids, avoiding straining, not spending long periods on the toilet, and washing the area gently with lukewarm water. More fluid and more fibre is the first-line measure, and a flavonoid tablet taken alongside a fibre supplement has also been shown to help.1 Ointments and suppositories can ease symptoms but do not treat the underlying pile.
A small rubber band is placed at the base of the pile, cutting off its blood supply so that it shrinks and drops off within a few days. It is a short outpatient procedure, does not usually need anaesthesia, and most people return to normal activity immediately. It suits first, second and third-degree piles1 and may need to be repeated. Occasionally there is bleeding one or two weeks afterwards, and it can be heavy,1 so do not hesitate to contact us if that happens.
Dr Chen will explain which options suit your grade and circumstances, and what each one means for recovery time and the chance of recurrence.
There is no single best treatment. Each one balances recovery time against the likelihood of recurrence, and what suits you depends on the grade of your piles.
| Option | Suits | The trade-off |
|---|---|---|
| Banding | First, second and third-degree piles1 | Least disruptive and usually no downtime, but may need repeating1 |
| Conventional haemorrhoidectomy | Third and fourth-degree piles | The most complete treatment and the lowest recurrence, but around 1 to 2% of patients have delayed bleeding1 |
| Stapled haemorrhoidopexy | Circumferential third and fourth-degree piles with little external component | Considerably less discomfort and an earlier return to normal activities, with a somewhat higher chance of recurrence1 |
| THD, or artery ligation | Selected cases where nothing needs to be cut away | Least painful of the operations, with recurrence rates that vary widely between published series |
Dr Chen will go through the options with you and what each one would involve.
BUILD NOTE: the THD row carries no citation. Neither NUH nor HealthHub covers THD, and the international recurrence figures range from 3% to 60% across studies, which is too wide to publish. Confirm with Dr Chen whether he offers THD and what he wants said about it.
An external pile can develop a blood clot inside it. This can cause a firm, tender, often bluish lump at the anal margin that appears over a few hours. It tends to be more uncomfortable than internal piles.1
It usually improves as the clot is reabsorbed, with the discomfort at its worst in the first few days. Where the pain is severe and you are seen early, the clot can be removed under local anaesthetic to relieve it more quickly. In cases where it is already improving, it is usually left to resolve on its own.
A skin tag sometimes remains afterwards. It is harmless, and removing it is a cosmetic decision rather than a medical one.
BUILD NOTE: this section carries no citations. No Singapore public-hospital source found covers thrombosed external piles, and the widely repeated 72-hour window for excision is not supported by current guidance. Dr Chen to confirm his own practice and timing at review.
Recovery varies considerably by procedure. Banding usually involves little or no downtime. After surgery, expect some discomfort on opening the bowels for the first week or two, and take the pain relief and stool softeners as prescribed. Warm baths help. Bleeding on passing stool for a short period is common. Dr Chen will provide specific advice based on the procedure you have.
After banding, expect some discomfort and an urge to open the bowels, which usually wears off after 2 to 3 days. Slight rectal bleeding is normal and is typically very minimal, less than a tablespoon, stopping within 1 to 2 days.3
Later bleeding is the exception to watch for. Bleeding one or two weeks after banding happens occasionally and can be heavy.1 That is different from the light spotting of the first couple of days, so do not hesitate to contact us if that happens.
Most people find the first few bowel movements harder than the wound itself. Three things make that period easier:
Some discharge and spotting from an open wound is expected. Wounds left open after a conventional haemorrhoidectomy heal from the base upwards, which is slower than a closed wound but avoids trapping infection.
Contact us if you have heavy or increasing bleeding, pain that is increasing rather than settling, fever, or difficulty passing urine.3
BUILD NOTE: confirm typical return-to-work guidance for each procedure with Dr Chen.
What you pay depends on which procedure is appropriate, whether it is done as day surgery or with an overnight stay, and on your insurance cover. MediSave can be used for approved day surgery, meaning a procedure on MOH’s Table of Surgical Procedures where you are admitted and discharged the same day.2 An Integrated Shield plan may cover part of the cost. We will give you a clear, personalised estimate, including what you can claim, before you decide.
See how our fees and claims work →
These procedures are commonly performed and serious complications are uncommon. As with any procedure there are risks, which Dr Chen will discuss in the context of your own health before you begin treatment. They include bleeding, difficulty passing urine shortly afterwards, infection, narrowing of the anal canal, and recurrence of the piles. Effects on continence are rare with the procedures described here.
No. Many people improve with changes to diet and bowel habit, and banding in an outpatient visit is often enough for first and second-degree piles. Surgery is generally reserved for third and fourth-degree piles or for symptoms that have not responded to simpler measures.
Banding is usually described as a feeling of fullness or mild discomfort rather than pain, and anaesthesia is not normally needed. Some aching for a day or two afterwards is common and usually settles with simple pain relief.
It depends on the procedure. Banding usually involves little or no downtime. Recovery after conventional haemorrhoidectomy takes longer than after stapled surgery or THD. Dr Chen will provide specific guidance for the procedure you are having.
Yes, recurrence is possible after any treatment, and the chance varies by procedure. Conventional haemorrhoidectomy has the lowest recurrence rate; less invasive options recover faster but carry a somewhat higher chance of symptoms returning. Maintaining good fibre and fluid intake and avoiding straining helps.
An external pile with a clot inside it. It appears over hours as a firm, tender, often bluish lump at the anal margin and is distinctly painful, which sets it apart from internal piles, where pain is not common.1 It usually resolves on its own as the clot is reabsorbed. Where pain is severe and you present early, the clot can be removed under local anaesthetic.
Slight rectal bleeding is normal and is typically very minimal, less than a tablespoon, stopping within 1 to 2 days, along with discomfort and an urge to open the bowels that wears off after 2 to 3 days.3 Bleeding one or two weeks later is different. It happens occasionally and can be heavy,1 so do not hesitate to contact us if that happens.
Conventional haemorrhoidectomy. It is the most complete treatment, but recovery is harder, with bleeding in around 1 to 2% of patients 7 to 14 days after surgery.1 Stapled haemorrhoidopexy involves considerably less discomfort and an earlier return to normal activities,1 with a somewhat higher chance of symptoms returning.
Keep stools soft, take pain relief as prescribed, and use warm baths after opening your bowels. Some discharge and spotting from an open wound is expected. Contact us for heavy or increasing bleeding, increasing pain, fever, or difficulty passing urine.3
BUILD NOTE: every figure on this page carries a numbered citation. Both sources were fetched and checked on 22 September 2026. Figures quoted are NUH's published rates, not this clinic's own outcomes, and the page says so. If Dr Chen wants his own figures used instead, they need to come from audited clinic data.
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