Piles (haemorrhoids) - Surgery 

Surgery for piles (haemorrhoids) 

Surgery may be recommended if other treatments for piles (haemorrhoids) have not been successful, or if you have haemorrhoids that are not suitable for non-surgical treatment.

There are many different surgical procedures for piles. The main types of operation are described below.

Haemorrhoidectomy

A haemorrhoidectomy is an operation to remove haemorrhoids. It is usually carried out under general anaesthetic, which means you will be asleep during the procedure and won't feel any pain while it is carried out.

A conventional haemorrhoidectomy involves gently opening the anus so the haemorrhoids can be cut out. You will need to take a week or so off work to recover.

You will probably experience significant pain after the operation, but you will be given painkillers. You may still have pain a few weeks after the procedure, which can also be controlled with painkillers. Seek medical advice if you have pain that continues for longer.

After having a haemorrhoidectomy, there is around a 1 in 20 chance of the haemorrhoids returning, which is lower than with non-surgical treatments. Adopting or continuing a high-fibre diet after surgery is recommended to reduce this risk.

Transanal haemorrhoidal dearterialisation (THD) or haemorrhoidal artery ligation (HALO)

Transanal haemorrhoidal dearterialisation (THD) or haemorrhoidal artery ligation (HALO) is an operation to reduce the blood flow to your haemorrhoids.

It's usually carried out under general anaesthetic and involves inserting a small device, which has a Doppler ultrasound probe attached, into your anus. This probe produces high-frequency sound waves that allow the surgeon to locate the blood vessels in and around your anal canal. These blood vessels supply blood to the haemorrhoid.

Each blood vessel is then stitched closed, to block the blood supply to the haemorrhoid. This causes the haemorrhoid to shrink over the following days and weeks. The stitches can also be used to reduce prolapsing haemorrhoids (haemorrhoids that hang down from the anus).

The National Institute for Health and Care Excellence (NICE) recommends this treatment as an effective alternative to a haemorrhoidectomy or stapled haemorrhoidopexy (see below). The procedure causes less pain and, in terms of results, a high level of satisfaction has been reported. Most people are able to return to their normal activities much sooner than with other surgical procedures.

There is a low risk of bleeding, pain when passing stools or the haemorrhoid becoming prolapsed after this procedure, but these usually improve within a few weeks.

Stapling

Stapling, also known as stapled haemorrhoidopexy, is an alternative to a conventional haemorrhoidectomy. It is sometimes used to treat prolapsed haemorrhoids and is carried out under general anaesthetic.

This procedure is not carried out as often as it used to, because it has a slightly higher risk of serious complications than the alternative treatments available.

During the operation, part of the anorectum (the last section of the large intestine), is stapled. This means the haemorrhoids are less likely to prolapse and it reduces the supply of blood to the haemorrhoids, which causes them to gradually shrink.

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. There have also been a very small number of serious complications following the stapling procedure, such as fistula to vagina in women (where a small channel develops between the anal canal and the vagina) or rectal perforation (where a hole develops in the rectum).

Other treatments

Other treatment options are available, including freezing and laser treatment. However, the number of NHS or private surgeons who perform these treatments is limited.

General risks of haemorrhoid surgery

Although the risk of serious problems is small, complications can occasionally occur after haemorrhoid surgery. These can include:

  • bleeding or passing blood clots, which may occur a week or so after the operation
  • infection, which may lead to a build-up of pus (an abscess) – you may be given a short course of antibiotics after surgery to reduce this risk
  • urinary retention (difficulty emptying your bladder)
  • faecal incontinence (the involuntarily passing of stools) 
  • anal fistula (a small channel that develops between the anal canal and surface of the skin, near the anus)
  • stenosis (narrowing of the anal canal) – this risk is highest if you have treatment on haemorrhoids that have developed in a ring around the lining of the anal canal

These problems can often be treated with medication or further surgery. Ask your surgeon to explain the risks in more detail before deciding to have surgery.

When to seek medical advice

Seek medical advice from the hospital unit where the surgery was carried out, or from your GP, if you experience:

  • excessive bleeding
  • a high temperature (fever)
  • problems urinating
  • worsening pain or swelling around your anus

If you are unable to contact the hospital or your GP, call NHS 111 for advice or visit your nearest accident and emergency (A&E) department.


Page last reviewed: 08/04/2014

Next review due: 08/04/2016

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Comments

The 9 comments posted are personal views. Any information they give has not been checked and may not be accurate.

dollywog said on 27 April 2014

I was looking through other peoples comments and I found this one about allergies to fish more precisely salmon steaks from scandy 24 dec 2012 I had a salmon steak prior to getting Thrombosed Heamorrhoids on Friday 25TH of April 2014 I wonder if there is a link and how to find out where you can be allergy tested

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choppedup said on 15 April 2014

Dont believe all the hype. I have had halo done 3 times by 2 different consultants for internal piles.. Pain free not.1st and 2nd time 3-4weeks off. 3rd time 5weeks due to pain and trauma. If you have a job with heavy lifting then you wont want to be doing that straight after..From my experience 1st and 2nd time only worked for 4-6months then bleeding returned. 3rd time (new cons) has lasted one year, occasional issues with bleeding after one year for me.. Previous to this had banding which was a waste of time and very painfull. Post surgery you need to be careful food wise. I took laxido which helped a lot. Lactulose was of no use post op 1st&2nd time
Yes I think it has helped but for me it is not an outright cure and may need to revisit the issue again due to occasional flare ups... suffered with internal piles on/off for 20years..

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Haemoballs said on 25 March 2014

I agree with Ondat... please read my lips - This procedure is not pain free! There is so much false news going on around that it is. I had the procedure about two weeks ago and still aching with pains plus other post surgery discomforts. You definitely need at least 10 days off work.
Doesn't help that you get discharged from the hospital with so much trauma in the rectum , yet the pain killers and laxatives prescribed (Cocodamol and Lactulose) have so much side effects e.g heavy constipation, constant loud uncontrollable flatulence, bloating , pains with every bowel movement that aggravates the trauma you will be undergoing already in the area .
You get virtually no support from the hospital staff on how to cope post surgery,, I'll say one definitely needs to go on a liquid diet (fruit smoothies and soups) to ensure a liquid stool to help to cope with bowel movement as they will be very painful otherwise because rectum becomes inflamed post surgery... I don't know how long this will last , but I tell you I'll rather this than the alternative for as long as it takes, next doctor appointment is in 8 weeks after surgery... no contact with him for answering questions before then!
After going through this, all my external piles are still as they are staring me in the face, so this procedure clearly doesn't cure those...only meant for internal piles .I was only hoping to cure my external piles as well..
Now I am wary about all the other promises I was told about the procedure, having found out the hard way about a lot I've been told already being false! So what is the long term side effect? Will my rectum ever get back to its normal state pre-surgery? It is all inflamed now and every bowel movement is very painful!, Will the piles come back, I know we are told they most likely wont but most of what Ive been told about this surgery hasn't been true so dont think I believe this anymore..
Long story short ...think properly before carrying out this procedure please!

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HildaGrey said on 14 March 2014

This week I had a consultation at my local hospital re. internal piles but was informed that funding had been withdrawn by doctors(as they now hold the purse strings) for this procedure. Has anyone else had this problem.

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Ondat said on 23 February 2014

I suffered with piles for 25 years, and when I heard about the THD /HALO procedure being pain free, with a quick recovery, and very effective, I decided to ask my doctor about it. My haemorrhoids had become so bad at times that I suffered for several days with prolapsed and thrombosed haemorrhoids in agony.

The procedure sounded less painful than a bout of piles, so I thought I had nothing to loose.

I had the THD procedure 6 days ago now, and it was not pain free, I still can't stand or sit for long without discomfort and bowel movements (even gas) are very painful. I have an ache almost constantly.

My surgeon confidently stated, "this is a painless procedure," but when I woke up from the 40 minute procedure under general anaesthetic, I had bowel contractions and pain akin to childbirth (I've had 2 children). I needed strong painkillers (tramaol, codeine etc) to cope with it, and despite drinking plenty of water, this caused constipation. I stopped taking cocodomal the day after surgery to try and limit this effect, but paracetamol and ibuprofen aren't really strong enough.

I'm hoping that the procedure will still be a success, but I just wanted to warn people not to trust the 'pain free' claims about the surgery. If you do decide to go fot it, plan for a longer and more difficult recovery than most sources suggest.

What have other people's experiences been?

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Scandy said on 24 December 2012

My external hemorrhoids and the painful attacks that I have suffered over 30 years are due to an allergy to Salmon and Herring. They effectively cause large swellings around my tail end around 8 to 12 hours after consumption and the effects can last up to 7 days (the time for the swelling to subside). I cannot find anything on the Internet linking this fish allergy to haemorrhoids. Hence this post.
If you read the symptoms of fish allergies it makes sense but there is no one linking the two together.
As it says on the Internet that up to 3% of people could have a fish allergy and that it is genetic, it may be a main reason why haemorrhoids are created and explains the subsequent attacks.
I can state clearly that my haemorrhoids were created as a direct result of my first fresh salmon steak.
I remember the incident well but never blamed the salmon and suspected another reason.
Only recently have I discovered this allergy, after a reaction to my first lobster, caused my throat to close up. This made me aware that I had an allergic reaction causing an area to swell up to closure.
I want the medical profession and people to wake up to fish allergies, as a cause of haemorrhoids !
Check out Red Vent disease in Salmon as the fish may only be the carrier of the offending allergen? They seem to have the same problem as me and 33% are affected!

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steve776 said on 17 April 2012

THD procedure was virtually pain free and allowed a quick return to sport/running etc. Brilliant.

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steve776 said on 17 April 2012

THD procedure was virtually pain free and allowed a quick return to sport/running etc. Brilliant.

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osram said on 07 February 2010

The THD method seems better than HALO.

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