Haemorrhoids (from the Greek “flowing blood”), more commonly referred to as piles, are a very common problem. The usual symptoms are bleeding, prolapse, skin irritation and occasionally painful episodes of thrombosis. Conservative treatment of a high fibre intake and adequate hydration are appropriate for early stage haemorrhoids however larger haemorrhoids will usually require treatment.

Outpatient treatments

Clinic treatments offered include injection sclerotherapy and banding.

INJECTION SCLEROTHERAPY involves the injection of 10mls of 5% phenol in almond oil into the tissue around the haemorrhoids. The tissue reaction around the injection results in shrinkage and fibrosis of the haemorrhoids. It is particularly useful for haemorrhoids that bleed but don’t prolapse. It causes only mild transient discomfort.

BANDING of haemorrhoids involves placing one or two tight rubber bands around the tissue just above the heamorrhoid. It interrupts the blood supply to the haemorrhoidal tissue and the tissue falls away after 7 to 10 days. It is very effective for larger prolapsing haemorrhoids and can avoid the requirement for surgery in many patients. It is not used in patients who are immunosupressed.

Banding is more uncomfortable than injection and causes a deep seated pelvic discomfort in some patients. This discomfort is nearly always gone within twelve hours. If you know you are going to a banding session it is useful to take two panadol and an anti-inflammatory before coming to the clinic. There is a small risk of heavy bleeding after “the scab” formed at the banding site falls off. This usually happens without warning between 7 and 10 days after treatment. If significant bleeding occurs please ring me or the clinic where you had the procedure performed for advice.

With both banding and injection reassessment and retreatment after 4-6 weeks is usual.

Surgical treatment

For large haemorrhoids that have failed outpatient treatment STAPLED HAEMORRHOIDECTOMY is now the most satisfactory operation. This operation replaces the prolapsed tissue back in the anal canal and secures it in place as well as excising excess tissue. The operation is performed inside the lower rectum and anus thus avoids surgery on the highly sensitive anal skin that caused so much pain after “traditional” haemorrhoidectomy. The surgery can be performed either as day stay or overnight stay surgery.

Large ANAL TAGS can be excised at the same time as stapled haemorrhoidectomy or removed under local anaesthetic if not associated with internal haemorrhoids. 

Keep your bowels working!

Make sure you don’t get constipated after surgery. Natural laxatives include kiwi fruit or processed variants (Kiwi crush or Necta). If needed take some extra fibre as Metamucil or Konsyl D, or a gentle laxative such as Lactulose.

Questions?

“Informed consent for surgery is a process not a piece of paper”. If you need more information about your proposed treatment please don’t hesitate to ask.

Useful websites

www.cssanz.org

www.fascrs.org

www.acpgbi.org.uk