Anal Diseases – An Uncomfortable Truth

While seldom talked about, anal diseases are more common than one might think. 

In Singapore, most adults in the age range of 30 to 50 years old have experienced some form of anal disease at some point in their lives. Anal diseases or anorectal disorders refer to medical conditions that occur in the junction of the anal canal and the rectum. 

These conditions may reflect internally or externally depending on the location of the condition.

In most cases, anal disease may be caused by bowel disorders that lead to damage to the lining along the rectal walls or, in rare cases, indicate conditions that are much more serious.

Often, if you have an anal disease, you may experience symptoms such as:

  • Pain near the anus or rectum
  • Rectal bleeding
  • Itching in the anal region
  • Blood in stools
  • Swelling in the anal region
  • Discharge after passing stools

In severe cases, anal diseases can lead to infections and sepsis, poisoning of the blood, which can be life-threatening.

“Most patients who experience anal disease usually come to us when they experience frequent bouts of itching and discomfort in the anus. Some patients also experience faecal leakage or bowel incontinence where they are unable to control faecal matter from leaking through the anus. It can be an embarrassing situation for patients. Still, it is vital for us as doctors to understand their condition to assess and recommend the ideal course of treatment to treat the disease effectively.” 

– Dr Ganesh Ramalingam, General Surgeon and Haemorrhoids Specialist, shares his insights on anal disease. 

There are different types of anal diseases; they include haemorrhoids (also known as piles), abscesses, and fissures. Each of these diseases differs in terms of treatment and severity.


“Piles, Haemorrhoids, when should I start worrying?”

Haemorrhoids, Piles, Anal Diseases, G & L Surgical Clinic, Dr Ganesh Ramalingam

Haemorrhoids (also known as piles) are swollen veins found in the lower rectum. There are two types of haemorrhoids: internal haemorrhoids and external haemorrhoids.

Internal haemorrhoids are usually painless but tend to lead to bleeding, while external haemorrhoids may cause pain. 

While there may not be a known cause for haemorrhoids, most cases of haemorrhoids are linked to straining during a bowel movement or chronic constipation. If you have haemorrhoids, you will usually experience a noticeable itching or pain around the anus.

In some cases, haemorrhoids can also lead to a lump near the anus.

Other symptoms of haemorrhoids include:

  • Faecal leakage
  • Pain during bowel movements
  • Blood in the stools after a bowel movement

Most cases of haemorrhoids are not serious and may go away on their own without any treatment. 

In more severe cases, patients may need to undergo additional treatment such as piles ligation or haemorrhoidectomy to treat the haemorrhoids. 

“For patients with recurring haemorrhoids, we will usually recommend that they consider piles ligation, a non-invasive procedure that involves tying a rubber band around the haemorrhoid to cut off the blood supply. Usually, the haemorrhoid will fall off from the lack of blood supply in one to two weeks.

In other cases where the piles are much more severe, patients may need to undergo surgery to remove the entire haemorrhoid, this procedure is called haemorrhoidectomy, and it is the most effective way in preventing a haemorrhoid from recurring.” 

Anal Abscesses

“I have an abscess beside my anus, should I be worried?”

Anal abscesses (also known as perianal abscesses) are small anal glands that become infected over time. They result in pus accumulating in the anus and can cause severe pain and discomfort. 

If you have an anal abscess, you may experience symptoms such as:

  • Constant pain or throbbing in the anus
  • Swelling in the anal region
  • Pain during bowel movement
  • Pus or discharge in the anus
  • Rectal bleeding
  • Urinary difficulties

Anal abscesses are often caused by inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. They are also associated with a weakened immune system attributed to illnesses such as HIV or AIDS. 

However, not all cases of anal abscesses are caused by these factors. Other factors such as constipation, anal sex, certain medications, or frequent diarrhoea contribute to the increased risk of developing anal abscesses.

Anal abscess rarely goes away without proper medical treatment. While you are not required to undergo major surgery, you will need a doctor to perform surgical drainage of the pus in the infected area before it turns chronic. 

Perianal Abscess, Abscess, Anal Diseases, G & L Surgical Clinic, Dr Ganesh Ramalingam

When left untreated, a chronic anal abscess can lead to tears along the anorectal walls, which are unable to heal and, over time, form an abnormal connection between the end of the bowel and the skin near the anus. This condition is known as anal fistula and will require surgery to fix the problem.

Anal Fissures

“I see fresh blood in my stools during bowel movement and I am experiencing pain, what’s going on?”

Anorectal Fissure, Anal Fissure, Anal Diseases, G & L Surgical Clinic, Dr Ganesh Ramalingam

An anal fissure or anorectal fissure is a small tear in the skin around the anus.

Anal fissures usually occur when hard or large stools are passed during bowel movement, resulting in excessive strain, which leads to the tear. If you have an anal fissure, you may experience pain and rectal bleeding in your subsequent bowel movements.

You may also experience the following symptoms:

  • Sharp pain during bowel movement
  • Visible bleeding in the stools or rectum
  • A visible tear in the skin near the anus
  • Irritation or itchiness around the anus
  • A lump on the skin around the anal fissure
  • Spasms in your anal sphincter at the bottom of your anus

While it is usually not a serious condition, anal fissures can affect individuals of all ages who experience constipation. They are more likely to cause a tear in the anal canal during bowel movements. 

Older adults are more prone to anal fissures due to decreased blood flow in the anorectal area. Women who are pregnant or have recently given birth are at higher risk for anal fissures due to straining during delivery.

In most cases, surgeries are seldom necessary as the tear heals on its own within four to six weeks.

However, if you experience anal fissures that do not heal even after eight weeks, you may have a chronic anal fissure.

“Most patients with anal fissures see their recovery within 1 to 2 weeks. However, in cases where the anal fissure does not heal, we usually recommend surgery to have it fixed. This is especially so if the patient has tried other treatments such as changing their diet and using laxatives in the initial weeks to reduce the strain during bowel movements. 

The procedure is known as Lateral Internal Sphincterotomy (LIS) is generally considered to be the most effective treatment for anal fissures, with more than 90 per cent of people experiencing good results in the long run.”


While talking discussing anal diseases can be uncomfortable, most anal conditions should not be left untreated. When left unattended, complications that may arise from these diseases can severely affect your lifestyle. 

Getting your anal disease diagnosed can be done discreetly, do not wait for the condition to worsen before seeking treatment.

If you or anyone you know is experiencing some discomfort in the anus or rectum and would like a professional assessment of the condition, consider scheduling a consultation to speak to our doctor.   


You may contact us directly via WHATSAPP or call our CLINIC.


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