Surgery may be recommended if other haemorrhoid (piles) treatments have not been successful. There are a number of different surgical procedures for piles.
A haemorrhoidectomy is an operation to remove the haemorrhoids. It may be recommended if injections (sclerotherapy) or banding have not been effective, or if you have large haemorrhoids causing severe pain and discomfort.
Haemorrhoidectomies are usually carried out under a general anaesthetic.
A traditional haemorrhoidectomy involves gently opening the anus so the haemorrhoids can be cut out. It is a major operation and you will need to take a week or so off work to recover.
It is likely you will experience significant pain after the operation, but you will be given painkillers to help. You may still have pain a few weeks after the procedure, which can also be controlled with painkillers. However, seek medical advice if you have pain that continues for longer.
If you begin to pass a lot of bright red blood or blood clots, contact your emergency doctor or go to your nearest accident and emergency (A&E) department immediately.
After having a haemorrhoidectomy, there is less chance of the haemorrhoids returning compared with injections or banding. However, a high-fibre diet is always recommended as a preventative measure.
Stapling, also known as stapled haemorrhoidopexy, is an alternative to a traditional haemorrhoidectomy. It is often used to treat prolapsed haemorrhoids (where the haemorrhoids hang out of your anus) and is carried out under general anaesthetic.
Your haemorrhoids are stapled to the wall of the anal canal (the last section of the large intestine), which reduces their blood supply and makes them smaller.
Stapling has a shorter recovery time than a traditional haemorrhoidectomy, and you will usually be able to return to work about a week afterwards. It also tends to be a less painful procedure.
However, after stapling, more people experience another prolapsed haemorrhoid compared with having a haemorrhoidectomy, and there have been a very small number of serious complications following the stapling procedure.
Haemorrhoidal artery ligation
Haemorrhoidal artery ligation (HALO), also known as transanal haemorrhoidal dearterialisation (THD), is an operation to reduce the blood flow to your haemorrhoids.
It's usually carried out under general anaesthetic and uses a small ultrasound device called a Doppler probe. Ultrasound is a procedure where high-frequency sound waves are used to create an image of the inside of the body.
The Doppler probe is used to identify areas in the bowel where an artery (blood vessel) supplies blood to a haemorrhoid. A stitch is then placed in each artery to block the blood supply to the haemorrhoid. This causes the haemorrhoid to shrink over the following days and weeks.
The National Institute for Health and Clinical Excellence (NICE) recommend haemorrhoidal artery ligation as an effective alternative to a haemorrhoidectomy or stapled haemorrhoidopexy. The procedure causes less pain and, in terms of results, a high level of satisfaction has been reported.
An expert panel of specialist advisers for NICE found haemorrhoidal artery ligation to be an effective method of relieving symptoms such as bleeding, itching, swelling and pain.
A study that looked at the progress of patients four weeks after having the procedure reported that symptoms had cleared up in 9 out of 10 people.
A review of a number of different studies looked at the results of haemorrhoidal artery ligation a year or more after the procedure. It found that about 1 in 10 people experienced:
- pain when passing stools
- a prolapsed haemorrhoid (where the haemorrhoid hangs out of the anus)
Other treatment options are available, including freezing and laser treatment. However, the number of NHS or private surgeons who perform these treatments is limited.