If other treatment has not worked on your piles (haemorrhoids), you may be referred to a surgeon. There are several different surgical procedures you can have. These are explained in more detail below.
Haemorrhoidectomy
If injections or banding have not treated your haemorrhoids successfully, or if your haemorrhoids are large and causing you a lot of pain and discomfort, you may be referred for a haemorrhoidectomy. This is an operation to remove the haemorrhoids and is usually done under a general anaesthetic (a painkilling medication that makes you unconscious).
A traditional haemorrhoidectomy involves gently stretching the anus (the opening at the end of the digestive system where solid waste leaves the body) while the haemorrhoids are cut away.
It is less likely that the haemorrhoids will come back after surgery than it is with injections or banding, but a high-fibre diet is always recommended as a preventative measure.
This is a major operation and you will need to take a week or so off work while the wounds heal.
It is common to have pain after this procedure, but you will be given painkillers to help you deal with it. You may still have some pain for a few weeks afterwards, but this can be controlled with painkillers. If the pain goes on for longer, seek medical advice.
If you start to pass a lot of bright red blood or pass clots, go to your nearest accident and emergency (A&E) department immediately.
Alternative procedures
Some alternative surgical procedures are explained below.
Stapling
Stapling, also known as stapled haemorrhoidopexy, is an alternative to a traditional haemorrhoidectomy. It is usually only done to treat prolapsed haemorrhoids (when the haemorrhoids are hanging out of your anus) and is carried out under general anaesthetic.
The haemorrhoids are stapled to the wall of the anal canal (the last section of the bowel), which reduces their blood supply and makes them smaller.
Stapling has a shorter recovery time than the traditional haemorrhoidectomy, and you can usually return to work in around a week. Stapling also tends to be less painful than a haemorrhoidectomy. However, after stapling, more people experience a further prolapsed haemorrhoid than after a haemorrhoidectomy.
Haemorrhoidal artery ligation
Haemorrhoidal artery ligation, also known as transanal haemorrhoidal dearterialisation (THD), is an operation to reduce the flow of blood to the haemorrhoids. It is usually carried out under general anaesthetic and uses a small ultrasound device called a Doppler probe. Ultrasound uses high-frequency sound waves to create an image of part of the inside of the body.
The Doppler probe is used to locate all the areas in the bowel where an artery (blood vessel) supplies blood to a haemorrhoid. A stitch is placed in these arteries so that the blood supply to the haemorrhoid is blocked. This causes the haemorrhoid to shrink over the following days and weeks.
Guidance from the National Institute for Health and Clinical Excellence (NICE) says that haemorrhoidal artery ligation is an effective alternative to a haemorrhoidectomy or stapled haemorrhoidopexy. It causes less pain after the operation and people have reported a high level of satisfaction with the results.
The Specialist Advisers for NICE, who are experts that provide informed opinions about medical procedures, found that haemorrhoidal artery ligation was effective for relieving symptoms such as bleeding, itching, swelling and pain. One study that looked at the progress of patients four weeks after having haemorrhoidal artery ligation found that 9 out of 10 said their symptoms had cleared up.
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:
- bleeding
- pain when passing stools
- a prolapsed haemorrhoid (where the haemorrhoid hangs out of the anus)
Other treatments
A few other options are available, but only a few surgeons carry them out on the NHS or in private clinics. These include freezing and laser treatment.
