Treatment options for haemorrhoids (piles) 

Treatment
Pros
Cons

Useful links

 

Lifestyle changes

Preventing constipation with a high-fibre diet and drinking plenty of fluids; avoiding straining while on the toilet

  • Can prevent smaller, internal haemorrhoids getting worse, increasing the chance they'll get better by themselves
  • High-fibre diet has other health benefits
  • Not usually effective in treating large haemorrhoids

Medication

Topical treatments

Creams, lotions or suppositories applied directly to the back passage

  • Can provide short-term relief from pain and itchiness
  • Many types available without prescription
  • Shouldn't be used for more than a week, because they can irritate the sensitive skin around your anus
Painkillers

Tablets, such as paracetamol

  • Can help relieve the discomfort caused by haemorrhoids
  • Usually no or few side effects
  • Many types available without prescription
  • Non-steroid anti-inflammatory drugs (NSAIDs), such as ibuprofen, can make rectal bleeding worse
  • Codeine painkillers can cause constipation
Laxatives

Tablets that can help you empty your bowels

  • Can help reduce straining on the toilet as a result of constipation
  • Many types available without prescription
  • Common side effects include flatulence, bloating and tummy (abdominal) pain

Non-surgical procedures

Banding

A rubber band is attached around the base of a haemorrhoid, which constricts the blood supply. The haemorrhoid falls off within around seven days

 

  • Proven long-term effectiveness in treating internal haemorrhoids
  • Treatment is usually painless and takes just a few minutes
  • Lower risk of side effects than surgery
  • Not suitable for external haemorrhoids
  • May need to be repeated if you have multiple haemorrhoids
  • Can cause bleeding, pain and ulcers (open sores)
  • May not be suitable if you're taking anticoagulant medication
Injection (sclerotherapy)

A chemical is injected into the blood vessels in your back passage, causing the haemorrhoid to shrivel up

  • Can be an effective treatment for internal haemorrhoids
  • Treatment can be carried out on an outpatient basis
  • Fewer side effects than banding
  • Not suitable for external haemorrhoids
  • Generally considered less effective than banding
  • Haemorrhoids often return
  • Can cause pain and bleeding
  • May not be suitable if you're taking anticoagulant medication
Electrotherapy

A small metal probe that emits an electric current is placed at the base of the haemorrhoid to coagulate (thicken) the blood supplying it. This causes the haemorrhoid to shrink

  • Proven to be an effective method of treating smaller haemorrhoids (grade one and two)
  • Treatment can be carried out on an outpatient basis
  • Fewer side effects than banding
  • Limited evidence for treating larger haemorrhoids (grade three and four)
  • Side effects can include pain and bleeding (although these tend to be short-lived)
  • New treatment, so availability may be limited

Surgery

Haemorrhoidectomy

Surgery to remove haemorrhoids

  • Effective in treating large and external haemorrhoids
  • Haemorrhoids less likely to return, compared to non-surgical treatment
  • You'll usually need to take a week or so off work to recover
  • Symptoms of pain can persist for several weeks after the operation
  • Can cause bleeding and problems passing urine and stools
Haemorrhoidopexy

Procedure to reduce haemorrhoids by stapling and removing part of the wall of the anorectum (the last section of the large intestine). This reduces their blood supply and makes them smaller

  • Effective in treating prolapsing haemorrhoids
  • Less post-operative pain compared to a haemorrhoidectomy, as well as a shorter recovery period
  • Although complications are uncommon, they can be serious if they do occur
  • Haemorrhoids more likely to recur than with a haemorrhoidectomy
  • Can cause a blockage in the anus or rectum, perforation (a hole) in the anus or rectum, and infection around the anus or rectum
Haemorrhoidal artery ligation

Where the blood vessels supplying haemorrhoids are sealed, reducing their blood supply and causing them to shrink. This pulls the haemorrhoids higher up into the anal canal

  • Effective in treating bleeding and prolapsing haemorrhoids
  • Less post-operative pain than haemorrhoidectomy or stapling
  • Evidence suggests it's a safe procedure
  • Works in up to 90% of cases 
  • Access to treatment on the NHS may be limited