Haemorrhoids: what are my surgical options?

Haemorrhoids (piles) are lumps that can appear inside and around your anus. Internal haemorrhoids can lead to bleeding from your bottom and anal prolapse, whilst external piles may cause itching and pain especially when sitting. We spoke to one of our expert colorectal surgeons Mr David McArthur about all of the treatment options available.
 

What are the non-surgical ways to treat haemorrhoids?

There are a number of ways to treat haemorrhoids. They are often caused by patients being constipated and we aim to rectify this first. This can be achieved through eating a high fibre diet (between 18-30g dietary fibre a day) and drinking adequate fluid (2-3 litres a day). Despite doing these things, some people will still be constipated and might benefit from a stool softening laxative.
 

What are the surgical options?

Not uncommonly, haemorrhoids regress when people address their constipation but in those who are still troubled, there are a number of “surgical” options, including those performed in a clinic setting and those requiring a full anaesthetic. Surgical options are:
 

Rubber Band Ligation (banding)

This effective yet simple treatment is suitable for grade I and II haemorrhoids. It can be performed in the clinic or at the same time as an investigation of the lower bowel. A special device is inserted into the anal canal to deliver a small, tight rubber band onto the base of the pile to cut off the blood flow. The haemorrhoid will shrink and fall off within a week. More than one procedure may be required to resolve the condition completely.
 

Transanal Haemorrhoidal Dearterialisation (THD)

THD is a painless procedure performed under a general anaesthetic. A Doppler probe is used to identify the site of the haemorrhoidal arteries within the anal canal. Once located, the surgeon ties the arteries off with an accurately placed stitch. Further stitches are required to pull the haemorrhoidal tissue back up inside the anal canal.

In most cases, patients resume normal activities within 24 – 48 hours. After the procedure, some patients report mild discomfort in the rectal area and an urge to defecate. Both symptoms usually disappear within a few days.
 

Rafaelo

The Rafaelo procedure uses radiofrequency technology to reduce or eliminate the common symptoms of haemorrhoids (grade I-III). It is a minimally invasive day case procedure and typically takes no longer than 15 minutes to perform. It can be carried out using a local anaesthetic, with or without a mild sedative. Most patients report very little pain or discomfort, and they resume normal activities quickly.

There is currently limited published evidence about how well it works, its long-term effects, or how safe it is for treating haemorrhoids. It has, however, been approved by The National Institute for Health and Care Excellence (NICE).
 

eXroid

eXroid applies a gentle current (electrotherapy) to the base of each haemorrhoid for up to ten minutes. During the procedure, the piles shrink. They often disappear completely, but if not they can continue to shrink for a week or more following treatment.

The majority of eXroid patients say that this straightforward procedure incurs minimal or no discomfort. Sedation and anaesthetic are not required. The patient may need more than one procedure to resolve the condition completely.
 

Conventional haemorrhoidectomy

The traditional haemorrhoidectomy is still considered the ‘gold standard’ of haemorrhoid surgery and is thought to provide the most durable results. It is performed under a general anaesthetic, usually as a day case. The haemorrhoids are excised and the wounds left open to heal naturally over the next few weeks.

However as it involves tissue removal, it is a more painful treatment than alternative minimally invasive techniques. Much effort has been spent in trying to make the operation more comfortable and it can now be undertaken as a day case in most instances.
 

Which procedures are the most painful?

Conventional haemorrhoidectomy is a painful procedure and the pain can last for a number of weeks afterwards. The newer, minimally invasive procedures, including THD, Rafaelo and eXroid tend to be a lot less painful, and therefore, when they are appropriate, are favoured as treatment modalities.
 

How long does recovery take?

This depends on the treatment undertaken. Following a haemorrhoidectomy, it might take between two to four weeks to recover to a point of being able to return to all normal activities. This is usually due to pain and healing wounds.

However, if haemorrhoids are treated by the newer, minimally invasive techniques, recovery often is straightaway and patients can return to their normal activities from the day after surgery.
 

How can a patient aid their recovery after surgery?

Keeping the bowel motion soft, through eating a high fibre diet and drinking plenty of fluid is a key component to aid recovery. Stool softening laxatives often help with this too. Having a course of antibiotics post-operatively has been shown in studies to reduce post-operative pain and aid recovery.

Using sitz baths, where one essentially sits in a warm water bath often containing Epsom salts can also help. Simple analgesic medications (painkillers) that don’t cause constipation can also provide relief. Some patients find relief from over-the-counter haemorrhoid creams that contain local anaesthetic.
 

How do I know if surgery is the best option for me?

Anyone who has symptoms from their bottom should get checked out. Firstly, we see lots of people who assume their symptoms are due to haemorrhoids when in fact they have another condition, such as an anal fissure, the treatment for which is different. If you do have haemorrhoids, a thorough assessment will allow your specialist to recommend which treatment option(s) is most appropriate for you.
 

If you are troubled by haemorrhoids, do not hesitate to book an appointment with Mr McArthur via his Top Doctor’s profile here or visit the Birmingham Haemorrhoid Clinic's website.