Haemorrhoids in women, explained by the surgeon who treats them

Haemorrhoids in women are common, and almost always treatable

Haemorrhoids are swollen veins in the lower rectum and anus, and in women pregnancy, childbirth and hormonal change all make them more likely. What you notice might be bleeding that does not hurt, itching, a lump you can feel, or discomfort when you sit. Hemorrhoids is the American spelling of the same condition, and female hemorrhoids differ from anyone else's only in what makes them likely.

Written by Dr Sulaiman Bin Yusof, Colorectal and General Surgeon. MBChB (Sheffield), M.Med (Surgery), FRCSEd (General Surgery).

Most women who come to see me about haemorrhoids in Singapore have been managing symptoms quietly for months, sometimes years. Whether it is bleeding after the toilet, discomfort when sitting, or the quiet worry that it might be something more serious, it is almost always treatable. The hardest part, for many patients, is making the first appointment. My goal is to bridge that gap with clear, unhurried, and discreet care.

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What this comes down to

17.2%

Of women, in the largest study of who gets them

Haemorrhoids are common, and only slightly more common in women than in men. What is different for women is not the everyday risk, it is that pregnancy, childbirth and the years around them add a burden men never carry. That is what the rest of this page is about.

Source: Hong et al., Scientific Reports, 2022, 194,620 adults

Found to have haemorrhoidal disease

Women: 17.2%
Men: 16.3%

Source: Hong et al., Scientific Reports, 2022

55%

Of people found to have haemorrhoids had no symptoms

Worth knowing before you read any further. When researchers examined nearly a thousand adults, 38.9% had haemorrhoids and more than half of those felt nothing at all. Having them is not the same as needing something done about them.

Source: Riss et al., Int J Colorectal Dis, 2012, 976 adults

Bleeding that keeps returning, or a lump that does not settle, is worth an assessment rather than another month of waiting.

Months

Sometimes years, before the first visit

How long most women who come to see me have been managing symptoms quietly before they make the appointment. The symptoms are rarely the difficult part. The appointment is.

Source: Dr Sulaiman Bin Yusof, clinical practice

Assessment
Rules out more serious conditions and points at the right treatment
Conservative measures
Dietary changes, topical treatments and sitz baths
Rubber band ligation
For milder haemorrhoids
Surgical excision
For more advanced haemorrhoids, and for skin tags with prolapse

What are haemorrhoids?

Haemorrhoids are swollen veins in the lower rectum and anus, which can lead to discomfort, pain, or bleeding.

In Singapore, colorectal conditions including haemorrhoids are among the most common reasons patients come to see a specialist surgeon. They are classified based on their location and characteristics.

Anatomical illustration, cross-section of the anal canal. A swollen purple internal haemorrhoid hangs into the canal from the rectal lining, and a cutaway at the right shows the cluster of dilated veins inside the surrounding tissue that the swelling is made of. — What a haemorrhoid actually is

Type	Where it sits and what it can do
Internal Haemorrhoids	Found inside the rectum, these may cause bleeding that does not hurt during bowel movements. In some cases, they may prolapse and protrude outside the anus, causing irritation or mild pain.
External Haemorrhoids	Located under the skin around the anus, these are often associated with pain, swelling, and itching. They may also cause bleeding if irritated.
Thrombosed Haemorrhoids	These occur when a clot forms in an external haemorrhoid, resulting in significant pain and swelling. They often present as a hard lump near the anus.

What causes haemorrhoids in women?

Various factors can contribute to the development of haemorrhoids in women, including those related to specific life stages and physiological changes.

Pregnancy and Childbirth

Hormonal changes during pregnancy increase blood flow and weaken vein walls, making them more susceptible to swelling. The growing uterus exerts additional pressure on the pelvic veins, and the strain from vaginal delivery can exacerbate the development of haemorrhoids.

Menstrual Cycle

Some women notice their symptoms flare at particular points in the cycle, most often when constipation or bloating comes with it. It is worth being straight about how well understood this is: no published study has established why, so treat it as a pattern women report rather than a proven mechanism. If it is happening to you, it is still worth managing.

After Menopause

Haemorrhoids do become more likely in these years. What the evidence supports is age itself: in the largest study of who develops them, covering 194,620 adults, older age was one of the strongest independent risk factors (Hong et al., Scientific Reports, 2022). The tissue supporting the anal cushions weakens over time, which is why prolapse becomes more common later on. A specific hormonal effect of menopause on those tissues has not been demonstrated, so it should not be presented as the reason.

Why pregnancy loads these veins

Hormonal changes increase blood flow and weaken vein walls
The growing uterus presses on the pelvic veins
The strain of vaginal delivery adds to both

More blood in, less of it draining back: the haemorrhoidal veins swell.

The three drivers his pregnancy paragraph describes, and what they converge on

35%

Of women had an anal problem in the weeks after giving birth

Of the 165 women followed through delivery, 58 had an anal problem afterwards: 33 a thrombosed external haemorrhoid, 25 a fissure. If this has happened to you, it is not unusual and it is not something you caused.

Source: Abramowitz et al., Diseases of the Colon & Rectum, 2002, 165 women

During pregnancy
Managed conservatively, with dietary changes, topical treatments and sitz baths
Until delivery
Surgery is generally deferred, unless there is a medical emergency
Post-partum
Rubber band ligation or surgical excision can be safely considered

General factors contributing to haemorrhoids

In addition to the female-specific causes, several general lifestyle and health factors can contribute to haemorrhoids in both men and women.

Sedentary Lifestyle

Long hours of sitting, whether due to work or other activities, increase pressure on the rectal veins and can lead to haemorrhoid development.

Chronic Constipation or Diarrhoea

Frequent straining during bowel movements, whether due to chronic constipation, irritation from persistent diarrhoea, or other factors, places significant pressure on the rectal veins, which can lead to the development or worsening of haemorrhoids.

Obesity

Excess body weight places additional pressure on the pelvic veins, raising the likelihood of developing haemorrhoids. This one has been measured: in a study of 976 adults, each single point of body mass index raised the risk by about 3.5% once other factors were accounted for (Riss et al., Int J Colorectal Dis, 2012).

Family History

A tendency to develop haemorrhoids can run in families, as some people may inherit weaker vein walls, making them more likely to experience the condition.

Ageing

Over time, the tissues supporting the rectal and anal veins may weaken, making haemorrhoids more common in older adults. This is the oldest established part of the picture: the anal cushions and their supporting tissue were described by Thomson in 1975, and older age remains an independent risk factor in the modern data (Hong et al., Scientific Reports, 2022).

Symptoms of haemorrhoids in women

Recognising the symptoms of haemorrhoids is key to seeking timely care. Symptoms can vary based on the type and severity of haemorrhoids.

Symptom group	What you typically notice
Symptoms of Internal Haemorrhoids	Bleeding that does not hurt during bowel movements is a common symptom, with blood often noticed on toilet paper or in the stool. If the haemorrhoid prolapses, it may cause irritation, itching, or mild discomfort.
Symptoms of External Haemorrhoids	These may cause swelling and tenderness around the anus. Pain during activities such as sitting or bowel movements is common, along with a persistent itching or burning sensation.
Symptoms of Thrombosed Haemorrhoids	Severe pain and noticeable swelling near the anus are key symptoms. A thrombosed haemorrhoid may appear as a hard lump and can sometimes have a bluish or purplish hue due to the presence of a blood clot.
Other Notable Symptoms	Mucus discharge from the anus and a persistent feeling of incomplete bowel evacuation are less common but notable symptoms of haemorrhoids. These issues can cause further discomfort and irritation, especially if combined with frequent wiping or inflammation.

What the colour and the pattern of the bleeding suggest, and the other conditions that produce the same thing, is set out in a separate article on anal bleeding.

Beyond piles: mucosal prolapse and skin tags

In my clinical experience, many women, especially post-partum, suffer from symptoms that are not purely caused by internal haemorrhoids. It is very common to see a combination of mild mucosal prolapse and haemorrhoidal prolapse associated with skin tags.

These are not just cosmetic concerns; they cause a range of symptoms including anal lumps, itching, irritation, and even bleeding. This often occurs without significant internal haemorrhoid involvement, or as a combination of both.

The treatment for skin tags with mucosal prolapse is surgical excision. If internal haemorrhoids are also present, both can be treated concurrently during a single procedure rather than in two separate ones.

49%

Had a recurrence within a year of a single banding

This is the trade-off, and it is worth having before you choose. Rubber band ligation asks very little of you, usually 1 to 2 days of downtime, but in the HubBLe randomised trial 87 of 176 banded patients had a recurrence within the year, and about a third of them went on to need a further procedure. A conventional haemorrhoidectomy asks a good deal more, 1 to 2 weeks of recovery and most patients back to normal activities within 2 to 3 weeks, and it is the more durable answer. Neither is the right answer for everyone.

Source: Brown et al., The Lancet, 2016, HubBLe trial, 372 patients

2.5%

Reported lasting incontinence after surgical removal

The honest downside of the bigger operation, and the number most pages leave out. Pooling the randomised trials, about 2.5% of patients reported incontinence persisting beyond three months, and about 5% in the first three months. Small, but not nothing, and worth weighing against how much the symptoms are costing you now.

Source: Jin et al., Surgery, 2025, pooled analysis of 139 studies

When to seek medical advice

Certain symptoms warrant prompt medical evaluation to rule out complications and ensure appropriate treatment. SingHealth puts the reason plainly on its own haemorrhoids page: these symptoms can mask the signs of something more serious, which is why they are worth examining rather than self-diagnosing.

Heavy or ongoing bleeding, severe pain and swelling, or fever, redness or pus around the anus should be seen promptly rather than watched.

Heavy or Persistent Bleeding

Ongoing bleeding can lead to anaemia and should be assessed to confirm it is caused by haemorrhoids and not another condition.

Severe Pain or Swelling

Intense discomfort, particularly with thrombosed haemorrhoids, may require immediate care to prevent worsening symptoms.

Signs of Infection

Symptoms like fever, redness, or pus discharge around the anus may indicate an infection and should be addressed urgently.

Lifestyle tips for reducing the risk of haemorrhoids in women

Simple adjustments can lower the likelihood of haemorrhoids and improve overall rectal health.

Fibre, water, regular movement and shorter visits to the toilet are the four adjustments that matter most here.

Dietary Changes

In Singapore, where hawker food can be low in fibre, constipation is a common driver of haemorrhoids. Simple swaps, adding leafy vegetables to your economy rice, choosing brown rice where available, or starting the day with fruit rather than kaya toast, can make a meaningful difference in long-term bowel health. Drinking plenty of water also softens stools and supports regular bowel movements.

Physical Activity

Regular exercise supports healthy digestion and reduces pressure on rectal veins. Avoiding prolonged sitting or standing is also beneficial.

Healthy Bowel Habits

Responding promptly to the urge to defecate and avoiding straining during bowel movements can reduce stress on the rectal veins. Using the toilet for shorter periods can also help prevent irritation.

The fibre advice is the one lifestyle measure with trial evidence behind it. A meta-analysis of seven randomised trials, 378 patients in all, found that fibre supplementation cut the risk of symptoms persisting by 47% and the risk of bleeding by 50% compared with a non-fibre control, with consistent results at six weeks and three months (Alonso-Coello et al., American Journal of Gastroenterology, 2006). The same review is candid about the limits: the trials were of moderate quality, and for prolapse, pain and itching the pooled results were compatible with no effect. Fibre helps the bleeding and the persistence; a haemorrhoid that prolapses needs the assessment described under when to seek medical advice.

What women ask about haemorrhoids

Is haemorrhoid surgery Medisave-claimable in Singapore?

Yes. Haemorrhoid surgery, including haemorrhoidectomy and rubber band ligation performed as a day surgery or inpatient procedure, is Medisave-claimable in Singapore. The claimable amount depends on the specific procedure and table of surgical procedures. Dr Sulaiman's clinic can provide a detailed cost estimate and assist with Medisave claims.

Can haemorrhoids be treated during pregnancy?

Most haemorrhoids during pregnancy are managed conservatively with dietary changes, topical treatments, and sitz baths. Surgical intervention is generally deferred until after delivery unless there is a medical emergency such as a severely thrombosed haemorrhoid. Post-partum, treatment options including rubber band ligation or surgical excision can be safely considered.

What is the difference between anal skin tags and piles?

Anal skin tags are small, soft folds of skin around the anus, often left behind after a resolved external haemorrhoid or pregnancy. Piles (haemorrhoids) are swollen blood vessels inside or outside the rectum. Both can cause discomfort and itching, but skin tags are not vascular and do not bleed on their own. In many post-partum women, both conditions coexist and can be treated together.

How long is the recovery after haemorrhoid treatment, and how often does it come back?

Recovery varies by procedure. Rubber band ligation typically requires minimal downtime, 1 to 2 days. A conventional haemorrhoidectomy may require 1 to 2 weeks of recovery, with most patients returning to normal activities within 2 to 3 weeks. Dr Sulaiman provides detailed post-operative care instructions tailored to each patient's procedure. Recovery is only half the question; the recurrence and complication figures are the other half. In the HubBLe trial, which randomised 372 patients and was published in The Lancet in 2016, 49% of those treated with a single rubber band ligation had a recurrence within the year, and about a third went on to need further treatment. Surgery is more durable but asks more: pooling 139 studies, about 2.5% of patients reported incontinence lasting beyond three months after surgical removal (Jin et al., Surgery, 2025). Both figures are worth having before you decide, and which one matters more depends on your grade of haemorrhoid and how much it is affecting you.

Are external haemorrhoids different in women?

External haemorrhoids (hemorrhoids, in the US spelling) are the same condition in women as in men: swollen vessels under the skin around the anus that cause swelling, tenderness, itching and sometimes bleeding when irritated, and a painful hard lump if a clot forms inside one. What differs is how often pregnancy and childbirth set them off. In the 165 women Abramowitz and colleagues followed through delivery, 33 developed a thrombosed external haemorrhoid in the weeks after giving birth. Treatment is the same as for anyone else, conservative first, with surgery deferred until after delivery unless there is an emergency.

When should I see a colorectal specialist about haemorrhoids?

You should consult a colorectal specialist in Singapore if you experience persistent bleeding, recurrent prolapse, symptoms lasting more than a week despite home treatment, or if you are unsure whether your symptoms are caused by haemorrhoids or another condition. Early specialist assessment can rule out more serious conditions and provide targeted treatment. This is not only my view: SingHealth makes the same point on its own haemorrhoids page, that these symptoms can mask the signs of something more serious and warrant proper examination rather than self-diagnosis.

Dr Sulaiman Bin Yusof

Senior Consultant Colorectal and General Surgeon, with over 20 years in surgery.

He wrote this article and is responsible for its clinical content.

Qualifications: MBChB (Sheffield)
M.Med (Surgery)
FRCSEd (General Surgery)
Fellowship: Peter MacCallum Cancer Centre, Melbourne
Previously: Former Director of Endoscopy, Changi General Hospital
Also: Visiting Consultant, Changi General Hospital

Getting seen

The first appointment is the hard part.

Haemorrhoids in women can arise from a combination of physiological changes, lifestyle factors, and age-related issues. Recognising the causes and symptoms early allows for effective management, which lowers the risk of complications and improves comfort.

Treatment options in Singapore range from rubber band ligation for mild cases to haemorrhoidectomy for more advanced haemorrhoids. If you are experiencing symptoms that may indicate haemorrhoids, message my clinic for personalised advice and treatment in Singapore.