• WHAT TO DO ABOUT HAEMORRHOIDS – TREATMENTS FOR HAEMORRHOIDS (PILES)

What are the Natural Ways to Treat Haemorrhoids?

What Dietary Changes can be Made to Help with Haemorrhoids?

Natural ways to treat haemorrhoids can include both dietary changes and lifestyle changes. If you suffer from haemorrhoids or piles, you may be directed to make dietary changes by your doctor or GP, to increase oral fluid and fibre intake thereby softening the stool, which may reduce the time spent sitting on the toilet and the need for straining during defecation.

What Foods to not Eat to Help with Haemorrhoids

Foods containing little fibre, such as white bread, dairy products, meat and processed foods, should be avoided as these can contribute to constipation and hence cause haemorrhoids.

Traditional Methods to Help with Haemorrhoids

Other traditional ways to help haemorrhoids centre around lifestyle improvements, avoiding straining when lifting may also prove beneficial.

Ways to Treat Haemorrhoids

What treatment options can you have to help with haemorrhoids?

A number of factors are known to be associated with the development of haemorrhoids, including increasing age, pregnancy and childbirth, chronic constipation, chronic diarrhoea, and family history of haemorrhoids. Estimates of the proportion of the UK population affected range from 4.4% to 24.5%. In 2004–5, approximately 23,000 haemorrhoidal procedures were carried out in England, of which approximately 8000 were excisional interventions. Whilst the above dietary and lifestyle changes may help avoid the development of haemorrhoids, there are a variety of surgical and non-surgical methods of treating haemorrhoids once they become a problem, depending on the grade. Smaller internal haemorrhoids may be treated successfully by rubber band ligation (banding) or injection, whilst the large external haemorrhoids are traditionally dealt with by surgical excision, known as haemorrhoidectomy. Here is a list of treatment options currently available, either privately or on the NHS.

For the smaller grade one and grade two haemorrhoids, without an external element but still symptomatic, there are a number of outpatient treatments available, albeit with limited success and generally a 50% chance of recurrence.

Non-Surgical Ways to Treat Haemorrhoids

Banding

Banding is usually carried out under local anaesthetic or sedation. It only takes a few minutes and involves a gun type device which shoots an elastic band around the inflamed cushion, designed to strangulate the haemorrhoid, thereby cutting off its blood supply. The tissue effectively dies and falls away. In practice it is difficult to ensure precise positioning of the band and in some cases, the band snaps or falls off before it has performed its function. This means that the procedure can fail, either immediately or soon afterwards, causing the haemorrhoid to remain. Even if the application is successful, it is said that there is a 30%-50% rate of recurrence, meaning that the process would have to be, and often is, repeated. The procedure itself is not without pain but this settles quite soon afterwards. This is typically the first line treatment offered on the NHS for minor haemorrhoids.

Sclerotherapy – Injections

Injections can be used as an alternative to banding. During the procedure known as sclerotherapy, a chemical solution is injected into the tissue thereby numbing the nerve endings and relieving discomfort. The aim of this procedure is to shrink the haemorrhoid by amaging the blood vessels which feed it, thereby reducing the flow of blood. It usually needs to be carried out several times in order to treat the larger haemorrhoids and are typically given every few weeks. This is not generally as painful as banding, but may need repeated applications. Often the principle of injecting a chemical into the body, makes this a less attractive option.

Surgical Ways to Treat Haemorrhoids

HAL (Haemhorroidal Artery Ligation)

HAL is generally used for grade 2 and 3 haemorrhoids and there is the option for HAL which is performed with a proctoscope modified to incorporate a Doppler transducer. There are two types of equipment in common use, known as HALO and THD. Both enable the detection of the feeder vessel to facilitate a targeted suture ligation of the Haemorrhoidal arteries. This procedure can be combined with a mucopexy suture for prolapsing haemorrhoids. HAL is performed under general anaesthetic as a day case procedure. The recovery can take up to 2 weeks during which the patient is likely to endure some discomfort. Time off work will be required. There is said to be a 30% recurrence rate with this process meaning that the symptoms might well recur with the procedure needing to be repeated. This is commonly offered privately and on the NHS.

Stapled Haemorrhoidectomy

Stapled haemorrhoidopexy is a technique that reduces the prolapse of haemorrhoidal tissue by excising a band of the prolapsed anal mucosa membrane above the dentate line, using a specific circular stapling device. This interrupts the blood supply to the haemorrhoids and reduces the potential for available rectal mucosa to prolapse. The procedure is referred to as a ‘pexy’ because the haemorrhoidal tissue is not excised as in conventional haemorrhoidectomy. Stapled haemorrhoidopexy is also known as ‘procedure for prolapse and haemorrhoids’ (PPH), stapled anopexy, stapled prolapsectomy and stapled mucosectomy. It has been used in the UK for several years. This is typically offered to treat the larger grade 4 prolapsing haemorrhoids and is carried out under general anaesthesia, most likely requiring an overnight stay in hospital.

Haemorrhoidectomy

Surgical haemorrhoidectomy is usually performed by the Milligan-Morgan (open) or Ferguson (closed) procedure. The Milligan-Morgan procedure involves dissection of the haemorrhoid and ligation of the vascular pedicle. The wounds are left open to heal naturally. The Milligan-Morgan procedure is thought to be relatively safe and effective for managing advanced haemorrhoidal disease, but because the anodermal wounds are left open healing is delayed, which may result in discomfort and prolonged postoperative morbidity. The Ferguson procedure is a modified version of the Milligan-Morgan technique, in which the wound is closed with a continuous suture to promote healing. A number of postoperative complications are associated with surgical haemorrhoidectomy. The short-term complications include pain, urinary retention, bleeding and perianal sepsis. Long-term complications may include anal fissure, anal stenosis, incontinence, fistula, and the recurrence of haemorrhoidal symptoms. Recovery can take at least 3 weeks (generally whilst suffering severe post-operative pain whilst the wound is allowed to heal). Haemorrhoidectomy is considered by NICE to be the gold standard in haemorrhoid treatment, with a relatively good success rate, but comes at the cost of considerable pain during and after the operation.

Introducing the Rafaelo Procedure

The Rafaelo Procedure is a modern, effective and revolutionary treatment for haemorrhoids. The surgery uses radio frequency technology as a method to remove or significantly reduce the symptoms of the common symptoms of internal haemorrhoids.

The Rafaelo Procedure Logo

“After over thirty years of General Surgery and twenty years of Colorectal Surgery experience, I am convinced that radiofrequency ablation (RAFAELO) is an appropriate, safe and effective treatment option for 2nd and 3rd degree haemorrhoids, which can be done under local anaesthesia. This is based on my experience of 75 cases within the last two years and after careful audit and patient satisfaction survey, with over six months follow up. I found 90% of my patients confirmed high satisfaction with minimal postoperative pain and early return to work in comparison to traditional Surgical excision. Only 4% of my patients required further procedure, half of whom were planned and staged treatment. Therefore, I currently offer RAFAELO as a first-line option to majority of my patients suffering from haemorrhoids because it is a safe, easy technique and effective short procedure with high success rate.”

Mr Alla Amin MBChB, MS, FRCS (England, Glasgow), FRCS(Colorectal)Consultant Laparoscopic General and Colorectal Surgeon West Herts Hospitals NHS Trust and Spire Harpenden and Bushey private Hospitals.

“As surgeons we have been searching over the centuries for a perfect procedure to control and treat haemorrhoids.  Haemorrhoids are basically varicose veins in the back passage.  They are meant to be there but over time and with constant wear and tear and increased intra-abdominal pressure they get bigger and cause significant symptoms.

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.  This is the new Rafaelo technique which is using radiofrequency ablation (microwave) surgery to help the haemorrhoids to shrink significantly.  This technique can be carried out under local anaesthesia or light general anaesthesia which is preferred by the majority of patients.  It is a quick application technique taking on average between 15 minutes to carry it out.  It is done as a day case without much preparation and the patient can walk home a couple of hours later.  So far I have performed approximately 16-20 cases and I am so impressed by the results.  The degree of pain experienced by patients is far less than the pain experienced by simple banding or excisional surgery.  Out of the 16 patients I have done so far there has been 1-2 who complained of pain lasting for a couple of days mainly because the haemorrhoids were too large and involving the anal skin causing the pain.  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).  Hopefully within the coming few months I should have a significant number of cases which I can publish and confirm what a fantastic and desirable procedure this is for such a problem which affects almost 80% of people.  In the long-term once I have a good number of patients over the coming couple of years with long-term follow-up I shall be able to publish some more results.  I hope I continue to perform this fantastic procedure for the foreseeable future.  Please let me know if you require any information.”

Mr Gamal Barsoum MD, FRCS, MB BCh, MRCS, LRCPConsultant General & Colorectal Surgeon practicing at Spire Parkway Hospital (Private) and Birmingham Heartlands & Solihull NHS Trust. Honorary Senior Clinical Lecturer, Birmingham University

“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 Nick West MBBS, MD(Res), FRCS (Gen)Consultant Colorectal & Laparoscopic Surgeon, Clinical Lead Department of Surgery, Epsom & St Helier University Hospitals NHS Trust & Consultant Surgeon Spire St Anthony’s Hospital, Surrey

“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”

Mr Amyn Haji MA MBBChir MSc MD FRCS Consultant Colorectal & Laparoscopic Surgeon, Clinical Lead for Endoscopy and Colorectal Surgery, Honorary Senior Lecturer King’s College Hospital, London.

“Having undertaken the first cohort of Rafaelo patients in the West Midlands, I am extremely excited over this revolutionary state of the art technology for the management of haemorrhoids.

‘Piles surgery’ has traditionally been a painful and highly morbid operation. Rafaelo has turned this on its head. The immediate advantage is the ability to avoid a general anaesthetic. This allows the patient to effectively walk in and walk out of the clinic following treatment. My own patients have had very little in the way of discomfort and initial follow up results are very pleasing both from a clinical response to treatment and from patient feedback.

I am receiving enquiries, almost on a daily basis now, for Rafaelo treatments and I am very confident that over time this will become a gold standard technique.”

Mr Patel’s private practice website can be found at www.mramitpatel.co.uk

Mr Amit Patel. MD FRCSMr Patel is a Consultant Laparoscopic General and Colorectal Surgeon. He is a Senior Academy Tutor at Worcestershire Acute NHS Trust and practices privately at Spire South Bank and BMI Droitwich Spa Hospitals.

“I am currently recommending the Rafaelo technique to my patients with haemorrhoids because our experience with this technique so far has been very positive. Patients experience good results with excellent resolution of their symptoms and very little pain or discomfort. So far we have largely treated Grade II haemorrhoids but some with Grade III haemorrhoids have also experienced good results. The biggest advantage for this technique is the lack of post-operative pain. It has always struck me over the 30 years of experience in surgery that although haemorrhoids can be painful and distressing over many years they are not dangerous and the treatment should not be worse than the problem”

Mr Joseph Ellul MB, BCh., MCh (Wales)., FRCSMr Ellul is a Consultant Colorectal and Laparoscopic Surgeon at BMI Chelsfield Hospital in Orpington, Kent and BMI The Sloane Hospital in Beckenham, Kent.

“After a very useful period of training in Germany using the Rafaelo procedure and equipment, I felt confident to perform this in my own practice since as Colorectal Surgeons we are all aware of how painful a ‘classical haemorrhoidectomy’ can be for our patients, and Rafaelo provides a fantastic alternative. I have used this now for some of the more ‘challenging’ prolapsing huge piles in patients who have ‘failed’ other types of haemorrhoidal treatments, with excellent initial audited results and patient satisfaction scores overall at 9.5 to 10 out of a maximum 10, and so far no failures of Rafaelo nor dissatisfied patients.”

Mr Stephen Warren BSc Hons, MB BS, FRCS, FRCS(Gen Surg), MSMr Warren is a laparoscopic general and colorectal surgeon operating out of BMI Kings Oak and Cavell Hospitals, as well as the Wellington and Highgate Hospitals in London.

“I have found the Rafaelo procedure to be a safe and effective alternative surgical treatment for Haemorrhoids using well established radio frequency technology. The majority of my patients undergoing this procedure have experienced minimal post-operative pain, if any at all, and have returned to normal activities much sooner than those who have undergone traditional surgery for haemorrhoids. I will be offering the Rafaelo Procedure as first line treatment to patients requiring surgical intervention for symptomatic haemorrhoids”

Mr Hitesh Patel MB ChB MS(Lon) FRCS(Eng) FRCS(Gen Surg)Consultant Colorectal Surgeon