Stapled Haemorrhoidectomy

Many individuals around the globe will suffer from haemorrhoids at some stage in their lives, particularly as they get older. Haemorrhoids – swollen veins in the anal or rectal area – occur when too much strain is placed on haemorrhoidal cushions, causing them to become inflamed, swell, and sometimes even bleed.

In most cases, haemorrhoids can be dealt with effectively through home remedies or over-the-counter solutions. However, in more extreme cases, surgery is required.

 

What exactly is a stapled haemorrhoidectomy?

Stapled haemorrhoidectomies (or haemorrhoidopexies) are most often used to treat third-degree haemorrhoids, which protrude from the anus as a result of straining during a bowel movement. A stapled haemorrhoidectomy procedure doesn’t actually remove haemorrhoids themselves, but instead, the loosened, expanded tissue around them is pinned back, halting the prolapsed effect.

“Stapling”, as it’s also known, is a relatively-new approach to treating haemorrhoids, and only became widespread in the late 90s. Some small-scale studies carried out on the procedure concluded that it was less painful than traditional haemorrhoidectomies and also healed faster. It was also suggested that stapling controlled future recurrence of haemorrhoid symptoms just as effectively as traditional approaches, leading to increased popularity and interest in the procedure.

 

How does it work?

During the stapled haemorrhoidectomy procedure, a hollow, circular tube is carefully inserted into the anal canal, through which a suture is threaded and woven into the anal canal above the internal haemorrhoids – the suture ends are drawn back out of the anus through the tube. A surgical stapler is pushed through the first tube and the lax haemorrhoid tissue below the haemorrhoid is pulled into the stapler’s jaws. When the suture is pulled, the haemorrhoid cushions are returned to their natural position in the anal canal, after which the stapler is triggered, cutting off the circumferential ring of excess tissue, sealing it at the upper and lower edges.

 

 

How long does the procedure take?

A stapled haemorrhoidectomy takes less time than a traditional haemorrhoidectomy (roughly half an hour), and is normally much less painful. Those who undergo the procedure are normally able to return to work faster than those on whom a traditional haemorrhoidectomy is administered. If your stapled haemorrhoidectomy is a day procedure, you’ll be able to go home once the anaesthetic has worn off and you can eat and drink comfortably. Patients may need someone to stay with them for 24 hours post-surgery to ensure they remain safe and stable.

 

Who should have a stapled haemorrhoidectomy?

People suffering from either internal or external haemorrhoids can turn to stapled haemorrhoidectomies as potential solutions to their problems. The procedure is normally used to treat third or fourth-degree haemorrhoids, though it can also be used for second-degree haemorrhoids that extend outside the anus during a bowel movement but retreat again of their own accord. Third-degree haemorrhoids must be pushed back into the anus following a bowel movement, but fourth-degree haemorrhoids will always remain outside and visible.

In some cases, a stapled haemorrhoidectomy can be combined with the removal of the external portion of the haemorrhoid to alleviate the problem, though if the external haemorrhoid is big enough, both the internal and external portions of the haemorrhoid may need to be removed through a traditional surgical haemorrhoidectomy.

 

Where do the staples go after surgery?

In the course of a stapled haemorrhoidectomy, the blood vessels within the haemorrhoid tissue that feed the haemorrhoid vessels themselves are cut off, effectively reducing the overall size of the haemorrhoid. While the damaged tissue around the haemorrhoid heals following the procedure, the scar tissue locks the haemorrhoidal cushions higher in the anal canal. Once the tissue has healed, the staples simply drop off and are passed in stool. Patients are unlikely to ever notice their staples passing.

 

  

Are there any complications with stapled haemorrhoidectomies?

Though stapled haemorrhoidectomies are more popular than ever, they are generally associated with a high risk of recurrence than the forms of haemorrhoid surgery normally performed, primarily because a stapled haemorrhoidectomy only reduces blood flow to loosened tissue rather than removing the haemorrhoid entirely, as would be the case in sclerotherapy, coagulation therapy or haemorrhoidal artery ligation.

 

The recurrence issue

A review published in The Cochrane Library analysed seven randomised clinical trials in which 537 people participated, the results of which showed that those who had undergone stapled haemorrhoidectomies were much more likely to experience recurrences of the condition than those who had their haemorrhoids removed completely. From a pool of 269 stapling patients, 23 suffered recurrences; in comparison, only four people from the surgical-removal group experienced recurrence of the condition. A substantial number of stapling patients also experienced haemorrhoid prolapse within and beyond a year of their procedures taking place, though the stapling approach was preferable in regard to pain, itchiness and the necessity for bowel movements.

“This study shows that stapled haemorrhoidopexy is associated with a greater risk of hemorrhoid recurrence and the symptom of prolapse in long-term follow-up compared to conventional excisional surgery,” explained Shiva Jayaraman Colquhoun, lead investigator in the study.

A general surgery resident at the University of Western Ontario also commented: “If surgeons are to offer this novel technique to their patients, there should be an informed discussion of the risks.

“This paper directly confronts the major concern with stapled haemorrhoidectomy, namely the long-term outcome,” an MD in private practice added.

“Proponents of this procedure argue it provides similar results to the open procedure with less pain, less disability and more rapid return to work. This paper states that the decreased pain and disability may entail increased risk of recurrence. As the authors note, patients must be advised of this increased risk.”

He concluded: “In all fairness, the increased risk, although statistically significant, is still clinically acceptable, 23 of 269 [stapled] patients versus four of 268 patients with conventional haemorrhoidectomy.

“Physicians and patients will therefore choose between a procedure carrying increased morbidity and disability with a low recurrence rate, and a procedure with decreased morbidity and disability and a higher recurrence rate.”

Which conditions share symptoms with haemorrhoids?

Haemorrhoids are a common condition affecting numerous people around the world every year. Also known as ‘piles’, haemorrhoids are thought to impact the lives of up to 75 per cent of people living in the United States alone, for example, with adults aged between 45 and 65 most often affected by it. The condition can be exacerbated by external factors such as obesity, pregnancy and sexual activity, and they can form both internally and externally to the anal area.

According to Dr. Herbert Lerner, a colon-rectal surgeon, “You often can’t see or feel the internal ones, but straining during bowel movements and constipation can cause these haemorrhoids to bleed and occasionally push through the anal opening.”

Anal bleeding can be quite alarming for anyone, and unfortunately, haemorrhoids aren’t the only condition that cause it. In fact, haemorrhoids share symptoms with several other more serious medical problems.

Common haemorrhoid symptoms in someone who has been diagnosed with haemorrhoids in the past can be treated at home,” explained Jason F. Hall, a colon and rectal surgeon at the Lahey Clinic in Burlington, Mass.

“Any new rectal bleeding or heavy rectal bleeding, especially in someone over age 40, should be evaluated.”

Haemorrhoids can cause significant and uncomfortable itchiness, pressure on the anus, and various degrees of pain, in addition to bleeding. It’s common for patients to feel a lump in the anal region, which can also be alarming.

 

How might a doctor check for haemorrhoids?

If you experience some of the aforementioned symptoms and fear you may have haemorrhoids, you should visit your doctor as soon as possible for a thorough diagnosis. During the examination, your doctor will need to inspect your anus for a number of potential haemorrhoid red flags, including:

  • Lumps and/or swelling
  • Stool or mucus leakage
  • Anal fissures (small itchy tear in the anus)
  • Skin tags (excess skin left behind after an external haemorrhoid blood clot dissolves)
  • Irritated skin
  • Prolapsed internal haemorrhoids that are visible through the anus
  • External haemorrhoids with a blood clot on the inside

In addition, your doctor may also carry out a digital rectal examination in order to determine the tone of the muscles in the anus, or check for any tenderness or lumps/masses in the rectal tissue.

If any examination on the day proves inconclusive, your doctor may refer you for a more extensive diagnosis procedure, such as a:

 

Rigid Proctosigmoidoscopy. This is a similar procedure to a anoscopy, in which a medical professional uses a proctoscope to examine the lining of your rectal region, as well as your lower colon. During this inspection, the tissue lining your rectum and lower colon will be assessed to find any indications of issues in the lower digestive tract, as well as hints of bowel disease. This procedure, which normally doesn’t require anaesthesia, can be carried out at your doctor’s office during a second visit, or you may be referred to a hospital or clinic elsewhere.

Anoscopy. In the case of an anoscopy, a medical professional will use an anoscope to inspect the lining of your anus and lower rectum, if required, carefully examining the tissue to identify any signs of bowel disease or lower digestive tract issues. As with a rigid proctosigmoidoscopy, this procedure can be performed at the doctor’s office and doesn’t normally require anaesthesia.

Haemorrhoids can also be diagnosed by a doctor during other procedures, such as colonoscopies or flexible sigmoidoscopies.

Which other conditions can cause haemorrhoid symptoms?

If you’ve tried a number of home remedies or over-the-counter medication and your haemorrhoids continue to cause issues, it’s time to seek medical help. Visit your doctor if you experience any of the following haemorrhoid-related symptoms:

  • Itchiness, pain, pressure or burning sensations that fail to respond to home treatments
  • Rectal bleeding (especially if it’s heavy or doesn’t respond to home treatments)
  • Additional symptoms like weight loss, fever, abdominal pain or a change in bowel movements

 

Jason F. Hall continues: “Haemorrhoids are common, but haemorrhoids symptoms that do not clear up quickly with home care or that keep coming back do need to be evaluated.

“The best place to start is with your primary caregiver. In many cases, a primary caregiver can make the right diagnosis and start you on the best treatment.

“If you need a diagnostic evaluation by a specialist, you may be sent to a gastroenterologist or a colon and rectal surgeon. If you need any surgical treatment, it should be done by a colon and rectal surgeon.”

When you have a good understand of what conditions produce symptoms similar to those of haemorrhoids, you can determine whether or not you can treat the condition at home first.

In the case of rectal or colon cancer, for instance, a patient may experience persistent bleeding, bowel movement changes, inexplicable weight loss or pain in the lower abdomen. “These cancers can occur near the rectum and cause bleeding and discomfort that are similar to haemorrhoid symptoms,” Hall adds. “Rectal and colon cancer are rare before age 40.”

Anal fissures are another condition that impacts on the anus, causing itchiness, pain, bleeding and a burning sensation. Anal fissures are usually caused by constipation but normally clear up with home treatment. Hall describes them a “small tears, like paper cuts, in the anal canal that can act very much like haemorrhoids.”

Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease, is also known to cause bleeding and discomfort in the rectum. IDB normally begins to affect people in young adulthood, and may cause a variety of haemorrhoid-like symptoms such as cramps, weight loss, fever and diarrhea.

Finally, pruritis ani. “This condition is frequently mistaken for haemorrhoids because it causes itching and burning in the rectal area,” says Hall. “It is actually a type of localised dermatitis.” The condition causes a seemingly-unrelenting urge to scratch, and often occurs as a result of an excess of moisture or sensitivity to a kind of food.

Another satisfied patient

“I had the Rafaelo Procedure in March. I have had painful haemorrhoids for over 30 years after the birth of my 2nd child. I had exhausted the NHS options available and decided to pay for this treatment. It was absolutely amazing, no pain, during or after. Two months later they have totally gone and this has made a massive difference to me. Kind regards, Mrs J A (Leeds)”

Which essential oils can I use for haemorrhoids?

Haemorrhoids

Haemorrhoids are a pain in the backside (literally). They occur when veins in the rectum and anus come under strain and swell, creating itchy lumps that can cause constant irritation. They can even bleed, which can be alarming for those who suffer from them. Haemorrhoids can appear internally (in the rectum) or externally.

A wide range of haemorrhoid treatments are available today at varying levels of expense and complication. Let’s look at just one possible avenue of treatment for this bothersome condition: essential oils.

 

What are essential oils?

According to TheThirty “Essential oils are highly concentrated, volatile plant extracts. We obtain essential oils through a few different extraction methods, and the part of the plant we get the essential oil from can be different depending on the oil but is typically the most aromatic part. Rose oil, for example, comes from the petals of the rose, while citrus oils come from the rind.”

“Because essential oils are obviously all-natural, it might be easy to assume that they’re gentle and largely unreactive. This isn’t the case at all—by definition, it’s extremely potent stuff. On average, they are up to 75 times more powerful than dried herbs. As such, essential oils must be handled with care.”

 

How can essential oils help treat haemorrhoids?

Essential oils have anti-inflammatory properties, which can help reduce the negative effects of haemorrhoids, which are by nature swollen vessels that require some form of treatment to bring down inflammation, otherwise they can worsen over time. Essential oils, as described above, are extremely potent and must be diluted in a carrier oil before being applied to the skin – they should not be administered directly to the skin or ingested. They can, however, be inhaled from a tissue or diffuser, with only a few drops necessary to achieve the desired outcome.

Here are a few types of essential oils you can use to treat haemorrhoids:

Horse chestnut

Horse chestnut seed extract can be used to reduce pain and swelling around the haemorrhoid area. It’s also used frequently for the treatment of varicose veins – you can buy creams made with horse chestnut to apply to external haemorrhoids. Don’t opt for this essential oil, however, if you have an allergy to latex or have upcoming surgery as it can slow the clotting of blood.

 

Peppermint

It certainly smells good anyway! Peppermint has long been used as a treatment for irritable bowel syndrome, and has been shown to help to some degree with haemorrhoids due to the combination of anti-inflammatories and menthol it contains. Peppermint essential oil can relieve haemorrhoid discomfort, but be wary if you have sensitive skin as it can be potent.

 

Frankincense

You may have heard of this one! Often associated with the Nativity account, Frankincense has been used for thousands of years to help ease inflammation and pain. It’s also highly effective at killing bacteria that lead to infection, which is an added bonus. You can easily dilute frankincense with carrier oil for direct application to haemorrhoids, or can inhale it through aromatherapy to benefit from its anti-inflammatory qualities.

 

Dill essential oil

Dill is another highly effective anti-inflammatory that can be combined with other oils to create a potent haemorrhoid ointment. Mix dill essential oil with witch hazel, tea tree oil and cypress to make an effective solution for haemorrhoids. Again, it can be potent, so dilute it with a carrier oil to keep it safe for application.

 

Myrtle

Myrtle essential oil is excellent at treating haemorrhoid pain and bleeding, but it’s absolutely essential that it’s diluted before application as it can cause severe allergic reactions and irritation to the skin otherwise. It’s a highly-effective essential oil, though, and should be considered by any haemorrhoid sufferer.

 

Cypress

Cypress essential oil is particularly effective at treating external haemorrhoids due to its soothing properties. It’s a natural antimicrobial and astringent that helps increase blood flow and reduce pain around haemorrhoids. It should always be applied with a carrier oil otherwise it can cause burning to the skin. It’s not ideal for those with sensitive skin.

 

Cinnamon bark

The essential oil derived from cinnamon bark effectively relieves inflammation and improves healthy tissue regeneration. Much like cypress essential oil, however, it isn’t a great option for people with sensitive skin. You can dilute cinnamon bark oil with coconut oil or almond oil to great a potent anti-inflammatory agent. Be very careful when applying cinnamon bark oil directly to an external haemorrhoid, however.

 

Clove

Clove oil cream is particularly useful for those with chronic anal fissures, an issue that sometimes goes hand in hand with haemorrhoids. You can buy it in its pure form or as part of a cream remedy. It’s also possible to make your own clove oil mixture by combining it with an unscented oil-based lotion. Again, those with sensitive skin should steer clear of this one.

 

Tea tree oil

Tea tree oil is another agent that is much too strong to apply directly to your skin. It can cause burning and increased pain, particularly if it’s applied to the haemorrhoid-affected region. However, it’s excellent at killing bacteria, increasing healing, and battling inflammation. Tea tree oil can be made using a combination of other essential oils and should be well-diluted prior to application. This is possibly the strongest option of those listed.

 

Are there any risks involved when using essential oils?

Essential oils can be a powerful and effective approach to treating haemorrhoids, but they must be handled with care. They should be thoroughly diluted with a carrier oil (like coconut oil) before application – 3 to 5 drops of essential oil for every ounce of carrier oil is generally the appropriate amount. You should never attempt to purge the skin area around the haemorrhoid with essential oil as this will cause extreme pain and potentially infection. They should not be used with internal haemorrhoids, and should never be taken orally as they can be highly toxic in some forms.

What is the best haemorrhoid treatment?

Whilst many treatments exist, there seems to be a pattern emerging amongst notable surgeons that The Rafaelo Procedure is a safe and reliable treatment for all grades of internal haemorrhoids.

If you suffer from irregular albeit repeating, symptoms of haemorrhoids, such as itching, bleeding, pain and/or mucus discharge, your GP will likely suggest a change in your diet (an increase in fibre intake) in order to put less pressure on your sphincter and surrounding tissue when trying to pass stools. This will reduce the likelihood of the blood vessels and anal tissue from becoming inflamed and swelling. In the meantime, he/she might suggest the use of topical creams which will reduce the symptoms in the interim.

Apart from off-the-shelf creams and lotions which are generally designed to temporarily quell the symptoms of haemorrhoids, there are a range of non-surgical and surgical treatments designed for more permanent relief of symptoms and the tissue mass associated with haemorrhoids, otherwise known as piles.

Historically, haemorrhoids were removed by way of a surgical procedure called Haemorrhoidectomy (Milligan Morgan method). This was, and is still today, a very invasive procedure, carried out under general anaesthetic in the operating theatre. The haemorrhoid is identified using a proctoscope and then is physically cut with a scalpel and scissors, leaving an open wound. This wound will heal over time leaving scarred tissue on the inside of the anal passage where the pile once was. The healing process can take several weeks, and is often very painful, particularly when attempting to pass stools during that period, and many people are forced to take 2-3 weeks off work to allow its recovery.

Statistically, the haemorrhoidectomy will be successful in 90% of cases, but it is not without the endurance of significant pain. Despite newer techniques having been adopted over the past 20 years, and despite the pain it causes to the patient, the Milligan Morgan technique still remains the gold standard for the removal of grade 3 and grade 4 haemorrhoids. There are numerous other haemorroidectomy techniques, such as The clamp and cautery haemorrhoidectomy, the open haemorrhoidectomy, closed haemorrhoidectomy, submucosal haemorrhoidectomy, whitehead circumferential haemorrhoidectomy, stapled haemorrhoidectomy, pile suture’ method, the bipolar diathermy haemorrhoidectomy, and the ligasure haemorrhoidectomy.

There are a number of non-surgical options however and these have developed over time.

Rubber Band Ligation

A very common procedure usually performed in an outpatient or day-case setting, where a band is placed tightly around the pile so to cut off its blood supply and cause it to fall away. This is a often used for the bleeding grade 1, 2 and 3 haemorrhoids but generally has a 30-50% recurrence rate meaning that by many it is considered to be a temporary fix and will often require repeat procedures.

Injection Sclerotherapy

A quantity of 1-3 mL of a sclerosing agent (5% phenol in almond or Arachis oil, sodium morrhuate or quinine urea) is injected into the submucosa of each haemorrhoid. The objective is to cause thrombosis of the vessels and promote fibrosis, which retracts the prolapse. This is still commonly used although, again the recurrence rate is in the region of 30% and is likely to require repeat procedures.

Haemorrhoid Artery Ligation (HALO)

Also known as THD, the surgeon can identify and ligate the haemorrhoidal arteries, using an embedded doppler, by placing a suture around them. This procedure is generally undertaken under general anaesthetic and can cause post operative pain. It is widely used on Grade 2 and Grade 3 haemorrhoids although in order for it to be effective, it is often combined with a mucopexy in order to discard the prolapsing element of the pile. Both HALO and THD, effectively the same technique but manufactured by two different companies, are said to be ineffective on large prolapsing Grade 4 piles. Both are said to have a 30% failure rate requiring repeat or alternative procedures to be carried out if it fails.

RAFAELO PROCEDURE (latest)

Utilising the safe and reliable technology known as radio frequency, the Rafaelo Procedure is the latest treatment available for the treatment of all grades of internal haemorrhoids. Carried out under local anaesthetic, with or without sedation to relax the patient, a probe is used to emit radio frequency energy (in the form of heat) into the pile causing the feeding blood vessel to close, the pile tissue to shrink and eventually fall away. This is carried out as a day case, it takes only a few minutes to carry out, with minimal pain during and post procedure, after which the patient is able to carry on with their normal daily activities without and significant downtime required. Current studies suggest that this is effective in circa 90% of cases and, since its launch in the UK, over 1,200 treatments have been carried out, with many more abroad.

Risks of anal surgery/procedures

All surgical and non-surgical treatments carried out in the anal passage carry the same risks including post-operative pain or discomfort, bleeding, infection, thrombosis and, in very few cases, incontinence. Your surgeon will explain the options to you and the corresponding risks of complication and recurrence. Make sure you are fully aware of the pro’s and con’s of your preferred treatment before embarking upon it.

Costs of Haemorrhoidal treatment

A variety of treatment options are offered in the UK on the NHS, but not all. The NHS has recently published a list of conditions which they are limiting treatment provision of, and one of those is haemorrhoidal treatment. Privately, either insured or self-pay, all treatments are available depending on where you live or are prepared to travel to. The latest treatments, such as The Rafaelo Procedure, are available in the majority of Spire Healthcare facilities across the UK. but also from many other organisations within the BMI, Ramsay, Nuffield and independent hospital groups. To find out where The Rafaelo Procedure can be performed, click here. Treatment costs range from a few hundred pounds for Banding and Sclerotherapy to circa £2,000+ for HALO and Rafaelo and up to £3,500 for Haemorroidectomies. When considering which treatment to opt for, if cost is an issue, take account of the likely recurrence rates for each and hence how many times it might need to be repeated.  Private medical insurers, such as BUPA, CIGNA, AVIVA and WPA cover Rafaelo and other procedures but do check with them first before committing to the treatment.

 

So what is the BEST treatment?

A good surgeon will always have a variety of treatment options available to him/her. It is important that they have a ‘tool box’ of treatments rather than just offering a select two based on his or her preference, as people present with differing symptoms, a more prepared than some for undergo surgery, and seek a variety of outcomes – not just clearance of symptoms but also the removal of unwanted tissue. Some people may have already tried some less invasive options such as banding, injections or electrotherapy which haven’t worked and who are seeking more effective, indeed more permanent, solutions.

Mr Gamal Barsoum FRCS, a very experienced and well respected colorectal surgeon in the West Midlands recently quoted “Over the years there have been variety of methods to treat haemorrhoids ranging from injection, banding and excisional surgery. Also Halo procedures with various modifications as in ligation and plication.  The fact that we have so many different methods denotes there has been no perfect procedure invented as yet.  However I am happy to say that finally we seem to have hit on an excellent technique to treat most degrees of haemorrhoids without causing much pain or discomfort.” He was referring to The Rafaelo Procedure. “The feedback I have had by every patient has been so encouraging and supportive that this is one of the best techniques discovered and introduced so far.  I offer it to all my patients now with recurrent and with 2nd degree up to 4th degree haemorrhoids without a significant external component (external haemorrhoids are skin tags)”.

Mr Nick West FRCS, an experienced surgeon in Surrey says “I have found the Rafaelo procedure to be a quick, comfortable and efficacious treatment for suitable symptomatic haemorrhoids. Using this new application of well-established radiofrequency technology I have patients who have avoided conventional haemorrhoidectomy surgery. Patients are able to return to normal activities quickly with little or no disruption and minimal or no post-procedure discomfort. I am pleased to be able to add the Rafaelo procedure to the options I have to treat patients with troublesome haemorrhoids”.

Mr Amyn Haji FRCS, clinical lead in Colorectal Surgery at Kings College Hospital, London, says “The procedure is quick and easy to perform with effective results. The most important aspect is that patients are pain free and can walk out of hospital to return to work the next day. This is a huge advantage compared to other haemorrhoid treatments available. I now plan to use The Rafaelo Procedure as first line treatment for prolapsing symptomatic piles in the future”.

So, whilst many treatments exist, there seems to be a pattern emerging amongst notable surgeons that The Rafaelo Procedure is a safe and reliable treatment for all grades of internal haemorrhoids, which avoids the need for general anaesthetic, and allows almost instant return to normal daily activities. To find out more, go to The Rafaelo Procedure.

 

 

What kind of fibre should I eat when I have haemorrhoids?

One of the most common pieces of advice you’ll receive if you have haemorrhoids (or want to avoid getting them) is “eat more fibre.” It’s actually pretty good advice to get for life in general, of course. However, in the case of haemorrhoids, are all kinds of fibre good for you? And why should you eat more of it anyway?

 

Why should I eat more fibre when I have haemorrhoids?

It’s good to consume plenty of fibre on a daily basis regardless of whether or not you have haemorrhoids. Fibre can help reduce your risk for a number of conditions, including stroke, cancer, heart disease and Type 2 diabetes. It can also help promote healthy gut bacteria and bowel movements, lower your cholesterol levels, help keep your body at a healthy weight, control your blood sugars, improve insulin sensitivity and reduce a variety of inflammation types.

An ideal amount of fibre to eat each day is 25-30 grams per 1,000 calories. The kinds of food you should be aiming to consume can include sunflower sprouts, chia seeds, cauliflower, broccoli, Brussels sprouts, mushrooms, mixed berries, onions, jicamas, sweet potatoes, beans and peas.

 

Are there different kinds of fibre?

There are two main kinds of fibre: soluble and insoluble.

Soluble fibre, as you might expect, dissolves in water to form a sort of gel. This is the best kind of fibre for softening your stool and making it easier to pass during a bowel movement. It helps you avoid becoming constipated and, in turn, avoid getting haemorrhoids or further irritating those you already have.

Insoluble fibre doesn’t dissolve in water. However, it helps keep everything ticking along nicely inside your digestive system and maintains a chemical balance inside your colon.

Ideally, you’ll want to eat a combination of soluble and insoluble fibre-rich foods (many of which contain both kinds of fibre), and aim to hit the 25-30 gram mark each day. About one third of your fibre intake should be soluble, though you should eat more if you have diarrhoea.

Don’t get carried away, though – it’s always possible to have too much of a good thing. If you eat too much fibre you’re likely to experience a lot of internal gas and bloating. You should also aim to drink plenty of water to help your body make use of the fibre it’s ingesting (8-10 tall glasses of water is the recommended amount per day).

What kinds of fibre-rich food should I eat?

Fruits and vegetables

Let’s start with the obvious one – fruits and vegetables. You’ll get loads of fibre from fresh fruit and veg, and there’s a huge variety to choose from.

You should leave the skins on your fruit when they’re the thin kind, like those you’ll find on pears, plums, apples and potatoes. The skins contain insoluble fibre along with special compounds called flavonoids, which are useful for controlling haemorrhoid bleeding. You’ll get most of your flavonoids from fruits and vegetables that are brightly-coloured, such as grapes, tomatoes, berries, kale, and dark-leafed vegetables. It’s best to keep them in one piece and avoid over-cooking them to get the maximum benefit from their flavonoids.

A single serving of fruit can give you at least 10% of your overall fibre intake for the day (about 3-4 grams), while you’ll get a slightly higher amount from leafy green vegetables, sprouts, broccoli, winter squash and green peas. Cucumbers, bell peppers, watermelon and celery all have high water content too (90%).

Try to add fruit or vegetables to all of your meals if you can – fruit with breakfast and lunch, veg with lunch and dinner. Be creative in how you add them to keep things interesting. Try to swap out biscuits and salty snacks during the day for dried fruit like dates, apricots and fig leaves.

 

Beans, lentils and nuts

Beans and lentils are extremely rich in fibre. A relatively-small amount of beans, such as navy, lima, black or kidney beans, can give you a boost of between 7 and 10 grams of fibre, which is about a third of your overall daily intake alone. They also contain both soluble and insoluble fibre.

Nuts are also excellent sources of fibre. A handful of pecans or almonds can contain as much as 3 grams of fibre on their own, as does a small portion of edamame. As with fruit and veg, try incorporating more beans and nuts into your dishes – Indian dishes in particular often use plenty of beans, so try out a few new recipes.

 

Whole grains

It’s all too easy to end up eating lots of bread throughout the day as it can be incorporated into most of your meals: toast for breakfast, sandwiches for lunch, garlic bread with dinner. All delicious, but not great for you.

Try swapping white breads, pastas and crackers for those made with whole-grain flours, stone-ground cornmeal and buckwheat or rye. You’ll get plenty of insoluble fibre from these. Ditch the whiter foods for those rich in oats and grains for a great fibre boost.

 

What shouldn’t I eat when I have haemorrhoids?

Fibre-rich foods are great for helping reduce your chances of becoming constipated and thereby lessen the risk of getting haemorrhoids. But while you increase your fibre intake, you should also decrease the amount of food you it that has little or no fibre in it, such as white bread, cheese, milk, meat, processed and fast food. Also avoid eating too much salty food and don’t drink too much caffeine as this can dehydrate you.

 

Can I take anything else?

If you’re struggling to get the amount of fibre in your diet up, you can try a dietary fibre supplement to give you a boost. One such supplement is organic psyllium, which works best alongside a diet rich in vegetables. Organic psyllium is “type of soluble fibre made from the husks of seeds from the Plantago ovata plant…it is a simple and cost-effective way of increasing your body’s fibre supply. Taking it three times a day could give you as much as 18 grams of dietary fibre.”

Can you pop a haemorrhoid?

It may not be the first thing that crosses your mind, but others have certainly tried it. The question is, can you actually pop a haemorrhoid? If you can, should you? And if you do pop it, what happens?

Let’s find out.

 

Can you pop a haemorrhoid?

Haemorrhoids, which are also known as piles, occur when veins in the rectum or anus become inflamed and swell, causing a great degree of discomfort for the sufferer. They can be itchy, painful, and can even bleed in some cases.

Internal haemorrhoids appear inside the rectum, while external haemorrhoids develop in the anus, just beneath the skin. They appear as swollen lumps, either individually or clumped together. When an internal haemorrhoid prolapses, it pushes out of the rectum into the anus. And in more extreme cases, a haemorrhoid can become thrombosed when a blood clot forms inside it.

External haemorrhoids, as well as prolapsed haemorrhoids and thrombosed external haemorrhoids, can feel to the sufferer like a pimple or spot, and many people try popping them in a similar fashion. It is possible to pop a haemorrhoid, and it can help release a build-up of blood.

It may not be the best idea, however.

 

Should I pop a haemorrhoid?

To begin with, haemorrhoids aren’t exactly positioned in a way that’s conducive for popping. Unless someone else pops it for you, you’re likely to have a lot of trouble popping a haemorrhoid yourself. It’s also very easy to injure the region around the haemorrhoid as the tissue in your anus is delicate, and exposing an open wound in an area that’s chock-full of bacteria can lead to infection occurring. It can also make a future diagnosis for more serious conditions (like cancer) more problematic.

And on top of all that, actually popping a haemorrhoid can result in a great deal of pain, during and after it’s actually been popped. They’re not spots or pimples, after all.

“People think they can pop a haemorrhoid the same way they do with a pimple. However, they are ignoring an important fact here.

“A bulging haemorrhoid is different in nature of that of a pimple. A pimple is located on the skin, and when popped it won’t cause any infection or scaring. With haemorrhoids things are much different. A haemorrhoid is a swollen rectal vein, which means it doesn’t stand alone by itself the same way the pimple does, but it is the end of rectal vein.

That’s why a thrombosed haemorrhoid is filled with blood clot inside, whereas a pimple contains pus underneath the skin.

So when you squeeze or pop a pimple, pus will emerge, which isn’t pleasant. But when you do the same with a haemorrhoid, you’ll have to deal with a lot more than pus squirting everywhere.

 

 

I’ve already popped my haemorrhoid…

You may have already gone ahead and popped your haemorrhoid, in which case you’re likely to now be experiencing quite a bit of pain. It’s important that, if you have popped your haemorrhoid, you see your doctor as soon as possible to ensure that no infection occurs. Your doctor will also be able to assess just how bad the haemorrhoid is and steer you in the right direction in regard to treatment.

However, if you can’t get to a medical professional quickly, look out for signs of infection around the haemorrhoid area, including: heat or redness, pus or discharge of fluid; swelling and inflammation, fatigue; fever; more pain than before when sitting down. Any of these symptoms could be a sign that you have an infection.

 

What are my options if I don’t want to pop my haemorrhoid?

No matter how itchy, painful or swollen your haemorrhoid becomes, you should always avoid squeezing or popping it – you may get some mild relief for a short time, but the long-term problems you’ll incur just won’t be worth it.

Instead of popping, try one of these approaches:

Use a cold compress. Wrap up an ice pack in a towel and hold it against your anus to help bring down the swelling. You can alternate this with a warm compress for added comfort. Always make sure you wrap the pack in a towel to stop it sticking to your skin and causing even more damage.

Use a sitz bath. Do this by soaking your anal region in some warm water, with optional Epsom salts added. You can buy a sitz bath from the local pharmacy.

Stay active. Avoid sitting for too long during the day, and limit your time on the toilet considerably. Don’t strain too much during a bowel movement either, as this can cause further irritation. Enjoy some light exercise but avoid any heavy lifting.

Stay clean. Use moist wipes to clean your anus after a bowel movement – toilet paper can be rough, and the abrasion can cause further irritation. Avoid any product that is perfumed with a fragrance as this can cause a bad reaction.

Try something from the pharmacy. You can purchase over-the-counter creams and ointments from your local pharmacy that can help ease your discomfort from haemorrhoids and curb your desire to pop them.

There’s also plenty you can do in terms of your everyday routine to both avoid getting haemorrhoids and help speed your recovery from them.

One of the primary causes of haemorrhoids is constipation – excessive strain placed on the rectal and anal regions causes vessels to swell and become inflamed, creating haemorrhoids. You can help ensure that your stool doesn’t become so hard that it’s difficult to pass by consuming plenty of fibre like fresh fruit and vegetables, as well as whole grains. You should also stay hydrated by drinking enough water during the day and lowering your caffeine intake.

If a dietary change doesn’t work, you can get stool softeners from the pharmacy or online. You should also stay active and try to maintain your usual routine as far as that’s possible with haemorrhoids. If none of this helps, there are plenty of non-surgical and surgical options, including the new Rafaelo Procedure.

To conclude – yes, haemorrhoids can be popped. Should you pop them? That’s up to you, but be prepared to deal with a lot of pain and probably a lot of rectal bleeding if you do.

Colon Cancer or Haemorrhoids?

If you happen to find blood in your stool, your mind will most likely jump straight to the most obvious conclusion: I have haemorrhoids. And in most cases, you would be right. However rectal bleeding is also a symptom of several much more serious diseases, including colon cancer. If blood appears in your stool, you should always consult a doctor, no matter what.

 

Signs

A number of other signs apart from rectal bleeding often accompany both haemorrhoids and colon cancer.

Internal haemorrhoids commonly present themselves with no symptoms at all, and are only discovered when blood appears in the stool during a bowel movement. If the haemorrhoid prolapses through the rectum into the anus, the sufferer may begin to experience a great deal of itchiness and sometimes pain. Haemorrhoids can also cause the sufferer to experience a constant feeling of needing to use the toilet (known as tenesmus). When a haemorrhoid becomes prolapsed, it can usually be felt as a lump expending out through the anus which can be pushed back in.

Colon cancer symptoms are usually quite different and more varied. Those with the condition will experience fatigue and have pale skin caused by anaemia. It will causes changes to occur in bowel movements as a tumour grows inside the colon.

If the colon tumour reaches a certain size, it can cause a bowel obstruction. If this occurs, the sufferer may experience abdominal distension, when the belly protrudes out further than usual with no associated weight gain. There may also be a degree of abdominal pain, though this would be unusual in the case of colon cancer. Sufferers may also experience inexplicable nausea and vomiting, as well as unexplained weight loss and a change in how often they need to use the toilet. They may also find that their stool becomes very narrow or they become constipated.

Colon cancer is normally diagnosed in most cases around 3 and a half months after symptoms first begin to manifest.

Causes

 

Haemorrhoids

Haemorrhoids are most often caused when endue pressure is exerted on blood vessels in the rectum and anus, causing haemorrhoids to inflame, dilate and swell as blood struggles to drain from them. This often leads to rectal bleeding.

There are a number of circumstances in which pressure is increased on blood vessels in the rectal and anal regions, leading to the appearance of haemorrhoids. While colon cancer can sometimes contribute to the occurrence of haemorrhoids, it’s rarely the root cause.

In most cases, excessive straining during a bowel movement or series of bowel movements causes haemorrhoids to appear. This often happens when an individual is suffering from diarrhoea or constipation, and can also be caused by too much time spent sitting on the toilet, or just be sitting too much in general (take walking breaks if you work in an office).

Other causes of haemorrhoids include a poor diet with low fibre, obesity, lack of regular exercise, disease of the liver, bowel disease, pregnancy, spinal cord injury of anal intercourse.

 

Colon cancer

Colon cancer normally derives from adenomatous polyps, which are made up of excessive numbers of cells growing in the glands on the inner wall of the colon. After a while, these growths enlarge and then degenerate, becoming adenocarcinomas. Certain individuals retain a genetic abnormality called familial adenomatous polyposis syndrome which increases their risk of developing cancer of the colon.

Other factors can also increase a person’s risk of developing colon cancer. These include having breast, uterine or ovarian cancer previously, having ulcerative colitis or Crohn’s disease, or having a history of colon cancer in the family. If someone has a first-degree relative with colon cancer, such as a parent or sibling, the risk of contracting the disease increases two to three times.

However, there are also a few additional factors which can make someone more likely to develop colon cancer. Firstly, if your diet is poor and you exercise infrequently, you’re more likely to suffer from it at some stage. Eating fibre-rich food like fruit and vegetables can help lower your chances of getting colon cancer, and cancer in general. Those who are obese, smoke or take drugs are all more likely to get colon cancer than those who don’t.

 

 

When to call the doctor

Haemorrhoids normally present very few symptoms, and those that do appear are not extreme, unless the haemorrhoids themselves become thrombosed. If you begin to develop any or all of the following symptoms, however, you should speak to your doctor immediately:

  • The frequency or nature of your bowel movements changes noticeably
  • You see bright red blood in your stool, on the toilet bowl, or on toilet paper after wiping
  • You begin to lose weight for no apparent reason
  • You feel pain in your abdomen, or your belly swells abnormally
  • You experience a sensation of incomplete evacuation following a bowel movement
  • You inexplicably vomit or feel nauseated on a frequent basis

If you experience the above symptoms, arrange to see your doctor as soon as possible, as they could be signs that you have colon cancer. However, if you experience the following symptoms, you should go straight to A&E:

  • A large amount of blood expels from your rectum and you suddenly feel weak and/or dizzy
  • You experience severe and inexplicable pain in your belly or groin area
  • You vomit profusely and can’t keep any fluids down

In the case of haemorrhoids, there are certain instances in which you should speak to your doctor as soon as possible. If you see blood in your stool, you should never brush it off – though it may be a case of very-treatable haemorrhoids, there’s also a real chance it could be a sign of colon cancer or bowel disease. Rectal bleeding should always be cause for concern.

It’s always better to be safe than sorry if you experience anything that you suspect may be either haemorrhoids or a form of cancer – if you’re worried at all, go straight to your doctor.

Non-Surgical Haemorrhoid Treatment types explained

A wide variety of haemorrhoids treatments exist (many of which we’ve already discussed in detail), but what exactly do we mean when we use the phrase ‘topical anaesthetics’, for instance? Let’s break down what each form of haemorrhoid treatment actually is.

 

Fibre supplements

Fibre supplements, first of all, are a subgroup of dietary fibre that helps increase the amount of fibre in the body’s digestive system, making bowel movements easier and reducing the likelihood of constipation. Numerous forms of fibre supplement are available, and can be consumed in the form of powders, tablets, or capsules. They can variously help improve dietary intake, lower blood cholesterol, assuage irritable bowel syndrome (IBS), lower the risk of colon cancer, and improve feelings of satiety.

Excessive fibre intake, however, can result in dehydration, fluid imbalance, mineral deficiencies, and other medical problems. Mayo Clinic explains in more detail:

“Fibre has a number of health benefits, including normalizing bowel function and preventing constipation. It’s best to get fibre from food, because supplements don’t provide the vitamins, minerals and other nutrients that fibre-rich foods do. But fibre supplements can contribute to the recommended daily intake.

“Fibre supplements can cause abdominal bloating and gas, at least initially. If you have intestinal problems, such as a history of a bowel blockage or Crohn’s disease, talk to your doctor before adding a fibre supplement to your diet. It’s also a good idea to ask your doctor or pharmacist whether fibre supplements interact with any medications you take.

“Fibre supplements can decrease the absorption of certain medications, such as aspirin, carbamazepine (Carbatrol, Epitol, others) and others. Fibre supplements can also reduce blood sugar levels, which may require an adjustment in your medications or insulin if you have diabetes.” Click here for more

 

Topical Anaesthetics

Topical anaesthetics are local anaesthetics used to numb the surface of a particular body part. Any area of the skin can be numbed with topical anaesthetics, as well as the front of the eyeball, inside of the nose, the ear or throat, the anus, and the genital area. They can help relieve haemorrhoid discomfort and discourage sufferers from scratching the affected area. Topical anaesthetics come in the form of creams, ointments, sprays, aerosols, lotions, and jellies; you can purchase them under the names benzocaine, butamben, dibucaine, lidocaine, oxybuprocaine, pramoxine, proparacaine, proxymetacaine, and tetracaine.

Topical anaesthetics can relieve a variety of pain types and discomforts around the body, including itching caused by sunburn or minor burns, insect bites or stings, poison ivy/oak, poison sumac, and minor cuts and scratches. They are effective at providing relief from haemorrhoid itchiness, though they do not act as a cure for the condition itself.

 

Laxatives and stool softeners 

One of the root causes of haemorrhoids is constipation. When too much strain is placed on the blood vessels in the rectum and anus during bowel movements, the vessels can become inflamed and swell, creating haemorrhoids in the region. It’s important to ensure that your bowel movements are easy and devoid of excessive strain, and the best way to do this is to keep your stool soft.

Laxatives, purgatives, and aperients can be used to loosen stools and improve bowel movements. They are commonly used to help individuals both avoid and treat constipation and, in turn, prevent haemorrhoids from occurring.

Laxatives can produce a variety of side effects in the body. Specific brands of stimulant, lubricant and saline laxatives help evacuate the colon ahead of rectal and bowel examinations – these can also be supplemented with enemas, if required. Too many laxatives can, of course, cause diarrhoea. They can be administered orally or rectally, and some often have multiple ingredients.

Stool softeners, which are also known as emollient laxatives, are anionic surfactants that encourage water and fat to absorb into stool, making it more straightforward to pass. Stool softeners typically take 12–72 hours to take effect. They are more often used to prevent constipation than treat chronic constipation.

 

Anti-inflammatories

Anti-inflammatories are substances that help reduce uncomfortable inflammation and swelling, and are particularly useful for those suffering from haemorrhoids. Anti-inflammatories tackle pain by reducing inflammation rather than block pain signals in the central nervous system, as in the case of opioids. According to the NHS:

“Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines that are widely used to relieve pain, reduce inflammation, and bring down a high temperature. They’re often used to relieve symptoms of headaches, painful periods, sprains and strains, colds and flu, arthritis, and other causes of long-term pain. Although NSAIDs are commonly used, they’re not suitable for everyone and can sometimes cause troublesome side effects.”

NSAIDs help ease pain by offsetting the cyclooxygenase (COX) enzyme, which synthesizes prostaglandins, generating inflammation in the body. NSAIDs stand in the way of this synthetisation process, effectively reducing or eliminating the pain. Some NSAIDs used every day by the general public are aspirin, ibuprofen, and naproxen.

There are, however, some significant side-effects to anti-inflammatories. According to Versus Arthritis

“Standard NSAIDs such as ibuprofen and naproxen work by blocking enzymes called COX 1 and COX 2, which are important in causing inflammation but can also affect the stomach. Newer NSAIDs (often referred to as coxibs) only block COX 2 enzymes and were designed to reduce side-effects, particularly on the digestive system.”

Studies have suggested that all NSAIDs are linked in some way with increasing your risk of having a heart attack or stroke, so avoid them if you’re a heavy smoker or if you’ve ever had “heart disease, a heart attack or stroke, peripheral vascular disease (circulation problems in the limbs, usually the legs), high blood pressure or cholesterol levels or diabetes.” (Versus Arthritis)

Anti-inflammatories are effective at reducing haemorrhoid pain and discomfort, but be careful to use them as directed.

 

Summary

So, while a wide variety of treatments are available for haemorrhoids, not all of them will suit every sufferer. Always consult your doctor before trying any over-the-counter medication, and make sure to keep within the prescribed dosage as you combat that painful anal condition.

What is Sclerotherapy treatment for Haemorrhoids?

Sclerotherapy is a non-surgical treatment in which a doctor will inject a solution called sclerosant directly into blood vessels, causing irritation that makes the vessel swell. That swelling leads to blood flow to the vessel being cut off, which results in it shrinking in size. It is most often used to treat varicose veins (or spider veins), but it can also be used to tackle haemorrhoids, as well as disorders of the blood and lymph vessels. Sclerotherapy has existed in a variety of forms since the 19th century, and approaches to it have vastly improved over the course of time.

Sclerotherapy is primarily used to treat varicose veins (also known as chronic venous insufficiency). It can lessen the appearance and associated symptoms of varicose veins, making them more manageable for sufferers.

The treatment is also used to tackle malformed lymph vessels, which carry lymphatic fluid or lymph around the body to help the immune system stave off infection. It can also be used to treat hydrocele, which are unhealthy build-ups of fluid inside a cavity in the body (these can often occur in the testicles).

Sclerotherapy is also used to treat haemorrhoids, especially in the event that other forms of treatment have proved to be ineffective.

Not everyone who has varicose veins, malformed vessels or haemorrhoids needs to opt for sclerotherapy, however. Medical professionals can recommend a number of different approaches to address these issues. In the case of haemorrhoids, for instance, non-prescription treatments can often reduce or eradicate them completely without the need for more extreme methods or surgery. Simply altering your diet or lifestyle can help sufferer’s manage their haemorrhoids without needing to consider sclerotherapy, or other similar approaches.

 

The Procedure

A sclerotherapy procedure can be carried out in the office of a dermatologist or GP – this will happen following a consultation with the doctor to determine the best course of action in terms of treatment. The procedure does not require the use of anesthetics or any similar such approach, though your doctor may provide you with a number of specific instructions to prepare for the treatment in advance.

When performing the procedure for piles, the doctor first cleanses the haemorrhoid area before a hardened chemical solution is injected directly into the vein, causing the tissue to scar and drastically lower the blood supply to the pile. After a short time, the blood vessel collapses, causing the haemorrhoid to shrink and go hard – it will eventually shrivel up entirely after around 4 to 6 weeks following treatment. Multiple haemorrhoids can be injected during the same procedure.

After the procedure is complete, a follow-up treatment is sometimes required to ensure that the blood vessel is fully collapsed and the haemorrhoid has shrunk sufficiently. Multiple treatments may be required for several haemorrhoids, but this is uncommon.

In the days following treatment, patients should remain active in order to avoid blood clots forming in the region, though it’s important to keep exercise light and avoid any heavy lifting or straining on the toilet. There may be some degree of tenderness and discomfort in the haemorrhoid region following the procedure, but this will pass quickly. Any pain can be treated with basic analgesic medication or painkillers.

Sclerotherapy is most commonly recommended by doctors when patients fail to respond to other forms of haemorrhoid treatment, though more basic approaches are often successful.

 

Complications

Sclerotherapy is considered a fairly safe procedure as it is much less invasive than surgery and has a significantly lower risk level. It also does not require anaesthesia, which is a major bonus.

In terms of varicose veins, sclerotherapy has been proven to work in 75-90 per cent of instances, but numerous treatments are often needed to fully resolve the issue. It is more straightforward when used to treat haemorrhoids. There are, however, a small number of potential side effects to the procedure, including bruising, redness and discomfort around the haemorrhoid region following successful treatment.

Patients may also experience mild pain following the days or weeks after their treatment, and may find that they have light rectal bleeding on and off for a short time after the procedure has been performed.

In rare cases, patients can experience an allergic reaction to the solution, which causes a burning sensation in the area; it is also possible for very small air bubbles to enter the bloodstream through the needle and cause headaches, nausea and problems with vision.

In the rarest of cases, a blood clot can appear in the treated blood vessel. These can be serious and life-threatening as they can travel through the bloodstream to other organs and cause major problems, such as an embolism. Anyone who experiences chest pain or has difficulty breathing following sclerotherapy should contact the emergency services at once.

 

Recovery and future of sclerotherapy

 During the recovery period, patients are likely to experience discomfort or a sensation of ‘fullness’ in the anus in the days following the procedure. Painkillers can be taken to reduce any discomfort, and recovering individuals can generally go about their daily lives as normal.

In some cases, patients may find spots of blood on their stool or on toilet paper after cleaning their anal region following a bowel movement, but this will pass quickly.

The NHS recently announced plans to reduce its use of up to 17 surgical procedures in an effort to save £200million per year. Treatments that are deemed “ineffective or too risky” will be avoided, meaning there will be up to 100,000-fewer procedures performed every year. Certain treatments for varicose veins and haemorrhoids will only be performed if the medical need for them is considered pressing or other approaches have failed.

The national medical director, Professor Stephen Powis, explained: “If we want the very best clinical care for our patients, we need to stop putting them through treatments where risks and harms outweigh the benefits.

“By reducing unnecessary or risky procedures for some patients we can get better outcomes while reducing waste and targeting resource to where it is most needed.”  Click here

Though this announcement may have only a limited affect on sclerotherapy procedures, it certainly could have some bearing on other forms of haemorrhoid treatment.