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.
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 and WPA cover Rafaelo and other procedures but do check with them first before committing to the treatment.