How are haemorrhoids treated?

Haemorrhoids are normal anatomical structures that everyone has. These anatomical structures are found on the top of the anal canal and if they become abnormal, by either growing in size, or becoming blocked, they can produce symptoms that will often require treatment. The type of treatment will be determined by whether your haemorrhoids are internal or external. Mr Gordon Neil Buchanan, an expert colorectal surgeon, explains what the different presentations of haemorrhoids are, and how each if usually treated.

What is the difference between internal and external haemorrhoids?

There are several different classifications for haemorrhoids. In simple terms, they can present either on the inside of the anal canal and patients may notice these haemorrhoids because they cause itching or discomfort. When they become larger they can prolapse out of the anal canal. They may spontaneously go back in after the patient has been to the toilet, but in many cases they won’t and the patient will have to push them back in on their own accord.

In some patients, their haemorrhoids will prolapse out and not actually go back in on their own even with pressure. In other patients, they will be external the whole time which has led to some of the different classifications. Patients can have a combination of internal and external haemorrhoids or they may purely have external haemorrhoids or they may purely have internal haemorrhoids.

The importance really is in the symptoms the patient has and also in the treatments that can be offered because internal haemorrhoids can largely be treated in the clinic and don’t usually need surgery unless clinic treatments fail. In external or prolapsing haemorrhoids, patients are much more likely to need banding and injections in the clinic, but are much more likely to progress to need surgical treatment or may need surgery from the outset.

How are haemorrhoids treated and is surgery required?

Haemorrhoids can be treated in several different ways. The first way is by lifestyle advice and the second is treatments that can be administered in the outpatient setting. Finally, for some patients, surgery will be advised dependent on the symptoms and the response to these more conservative measures.

In terms of lifestyle advice, many patients’ symptoms will simply improve on adopting a high fibre diet, avoiding straining on the toilet and adding more fluid to their diet. Such lifestyle changes will often take away some of the symptoms of early haemorrhoids.

Some patients will use over-the-counter remedies, but whilst this might improve the symptoms, they sometimes won’t get rid of the condition such that patients will often present to their GP or a specialist because these simple methods haven’t worked.

In the outpatient setting, we can do simple techniques like injecting the haemorrhoids particularly for ones that are internal. Slightly larger, external or prolapsing haemorrhoids can be treated by banding. This will really only treat the internal components of haemorrhoids, but will often improve the symptoms.

Repeated injections or bandings are often feasible, but some patients will either present or will progress to develop haemorrhoids that may need surgical therapy. You can really divide surgery into surgery which cuts the haemorrhoids away, stitches them back inside or staples them back in place. For fixed external haemorrhoids, I tend to favour cutting them away and for haemorrhoids to reduce internally, they can be managed by stitching them back inside and tying off the arterial supply which is a technique known as THD (transanal hemorrhoidal dearterialisation).

Using a combination of these techniques, we can usually obtain a fantastic result for most patients.

If you would like to find out more, make an appointment with a specialist.