Haemorrhoids (Piles)

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Haemorrhoids also commonly known as piles are anal prominent vascular cushions which often bleed when irritated by constipation or diarrhoea. Sometimes they can get painful too, particularly when thrombosed or prolapsed.  

Haemorrhoids are the commonest cause of rectal bleeding, however it is important to rule out something sinister like bowel cancer when bleeding symptoms persist. They differ from grade 1 to grade 4 haemorrhoids.

Treatment of haemorrhoids depend on the grading made on careful examination, which sometimes may even require an examination under anaesthetic to decide the best type of treatment suited to an individual. Mr Gupta offers following invasive treatments for haemorrhoids when required 

• Injection sclerotherapy
• Rubber band ligation
• RAFAELO procedure
• HALO
• Haemorrhoidectomy

Often a flexible sigmoidoscopy or colonoscopy is required prior to haemorrhoids treatment to ensure there is no other synchronous colonic pathology. Injection sclerotherapy or rubber band ligation are ususally suitable for grade 1 to grade 2 haemorrhoids, and can be performed without the need for general anaesthetic. The results are variable and sometimes the process has to be repeated to get better results. 

RAFAELO (RAdio Frequency treatment of hAEmorrhoids under LOcal anaesthetic) procedure is a relatively newer technique to treat small grade 1-2 haemorrhoids by injecting radiofrequency current in the hamorrhoids. It can be performed under sedation, however a general anaesthesia is sometimes preferable. Ususally a quicker return to normal activities without any significant pain is expected after this treatment. This treatment is not yet available in the NHS.

HALO (Haemorrhoidal Artery Ligation Operation) for grade 2-4 haemorrhoids requires a general anaesthetic and is particularly preferred for patients with circumferential internal piles (see image before and after HALO). Recto-Anal Repair (RAR) is often combined with HALO. Essentially stitches are taken inside under sound doppler guidance to cut off blood supply to haemorrhoids allowing significant shrinkage. Post operative pain is expected for few days. Conventional haemorrhoidectomy still remains a very well tried and tested method to treat large external haemorrhoids. Post-operative pain is expected, and it needs a general anaesthetic.