Haemorrhoid Treatment options
Depending on your diagnosis, internal and external haemorrhoids can be treated in a variety of specialised ways.
While haemorrhoids can often be effectively managed by simple local medication, and dietary and lifestyle changes, sometimes specialist treatment needs to be undertaken at the Haemorrhoid Clinic, or in hospital.
Conservative treatment typically consists of increasing dietary fibre, oral fluids to maintain hydration, non-steroidal anti-inflammatory drugs (NSAID)s, sitz baths, and rest. Increased fibre intake has been shown to improve outcomes, and may be achieved by dietary alterations or the consumption of fibre supplements.
Many topical agents and suppositories are available for the treatment of haemorrhoids. See the www.pilesadvice.co.uk site for further information. We give complex guidance on how to use them.
When specialist treatment is required, our doctor could perform the following procedures:
- Rubber band ligation. This is a simpler office or room’s treatment for haemorrhoids as opposed to surgery, which usually takes place in hospital. No anaesthetic is required and you are able to go home almost immediately. This is a procedure in which elastic bands are applied onto an internal haemorrhoid at least 1 cm above the dentate line to cut off its blood supply. Within 5–7 days, the withered haemorrhoid falls off. Cure rate has been found to be about 87%.
Advantages of rubber band ligation:
- no hospitalisation
- no anaesthetic
- minimal pain
- minimal time off work
Possible disadvantages:
- may require more than one course of treatment.
- does not deal with external skin tags and loose skin of haemorrhoids.
- there is a small risk of complications such as aggravation of other haemorrhoids, bleeding, pain or infection. The pain is difficult to predict and is usually not severe. There is a bearing down sensation sometimes and Paracetamol taken after the procedure is helpful.
-
Sclerotherapy involves the injection of a sclerosing agent, such as phenol, into the haemorrhoid. This causes the vein walls to collapse and the haemorrhoids to shrivel up.
This is useful for treating bleeding haemorrhoids. Some Surgeons prefer this technique for first and second-degree haemorrhoids – those that don’t prolapse much outside the anal canal. It can be very useful where the bleeding is severe.
It is usually very safe and painless.The injection is given through a proctoscope and is usually carried out in the Doctor’s office. No Anaesthetic is required.The Doctor visualises the haemorrhoids and injects with a special syringe and needle, Phenol in almond oil. Only a small volume is used 2 or 3 mls. The injection is placed just above the haemorrhoids under the lining of the bowel, not too deeply so as to avoid inflammation in adjacent organs. Sometimes one haemorrhoid is injection or sometimes two to three depending on circumstances. The patient is usually reviewed three weeks later to assess the results. A further injection may be necessary.The risks of this procedure are fairly low, but as with all procedures care needs to be taken.
Infection, ulceration and bleeding are other remote possibilities.
The success rate four years after treatment is 70%.
A number of surgical techniques may be used if conservative medical management fails. All are associated with some degree of complications including urinary retention due close proximity to the rectum of the nerves that supply the bladder, bleeding, infection, and anal strictures.
- Haemorrhoidectomy is a surgical excision of the haemorrhoid. This is used rarely nowadays, usually only in severe cases. It is associated with significant post operative pain and usually requires 2–4 weeks for recovery.
- Doppler guided transanal haemorrhoidal dearterialization is a minimally invasive treatment using an ultrasound doppler to accurately locate the arterial blood inflow. These arteries are then "tied off" and the prolapsed tissue is sutured back to its normal position. It has a slightly higher recurrence rate, however, there are less complications compared to a haemorrhoidectomy.
- Stapled haemorrhoidectomy (Longo operation) is a procedure that involves resection of soft tissue proximal to the dentate line, disrupting the blood flow to the haemorrhoids. It is generally less painful than complete removal of haemorrhoids, and is associated with faster healing compared to the traditional haemorrhoidectomy. Our specialist will give you advice about the optimal treatment.
