A) Banding of piles

How does the treatment work?

Banding of piles is done as an outpatient treatment and only takes a few minutes. Using a short telescope, tiny rubber bands are placed inside the back passage above the piles. This constricts (tightens) and cuts off the blood supply to the piles. Over the next few weeks, the piles then shrivel up, hopefully leading to an improvement in your symptoms.

How will I feel when I get home?

You may have some discomfort for 1 – 7 days after this procedure. This can be relieved by having a warm bath and taking painkillers, for example, paracetamol. Do not take painkillers containing codeine as these can cause constipation

If you have:

• increased pain
• bleeding or discharge from your rectum (back passage)
• difficulty passing urine
• swelling in your rectum

you should contact your doctor.

Will I have a wound or dressing?

One or more haemorrhoids will have been banded (a special rubber band placed round the base of your haemorrhoid) during your procedure. The area does not need a dressing and there is no wound. It is important to keep the area clean by bathing once or twice a day and also by washing the area after having your bowels opened. You should not add any products, for example, bath foam or oils to your bath water.

Can I eat and drink normally?

Yes, you can eat and drink as normal but it is important you do not become constipated and need to strain to have your bowels opened. Try to include foods high in fibre in your diet, for example, wholemeal bread, wholegrain cereals

What will happen when I go to the toilet?

It may feel quiet tender as you open your bowels and there may be a little bleeding. Try not to force the motion. It is important to clean the area by washing after having your bowels opened.

What happens to the rubber band?

You may notice some of the bands being passed in your stool (faeces, poo), and sometimes a little bleeding may also occur as a band is passed. This is nothing to worry about.

When can I return to my normal activities and work?

You can usually return to all your normal activities and work straight away, or as soon as you feel well enough.

Surgical options

Around 1 in 10 people with piles will end up needing surgery.

B) THD (Trans anal Haemorrhoidal Dearterialization)

This procedure is cutting-edge operation which has revolutionised the surgical treatment of haemorrhoids. This procedure use a mini-Doppler ultrasound probe to identify and treat the blood vessels which supply the haemorrhoids, thereby causing them to shrink. This allows patients to return home on the same day of treatment with minimal post-operative pain.

Is THD right for me?

If you’ve been diagnosed with Grade 2, 3 or 4 haemorrhoids and your GP or consultant has recommended surgery, you may be eligible for THD.

What happens during THD?

During the THD procedure, the blood-supplying arteries of the haemorrhoid are precisely located with a fine, specially designed proctoscope allowing maximum precision via a doppler ultrasound probe. Each of these arteries is then gently sutured through a small operating window of the same proctoscope.

In case of prolapsed haemorrhoidal cushions (3rd and 4th-degree haemorrhoids), a running suture with a few stitches is applied to the prolapsed piles, being careful that all stitches remain above the dentate line. The aim is a firmer adhesion of the mucosa to the deep layers of the rectal wall.

The THD procedure differs from other surgical techniques in the following ways:

• It uses the same fine instrument for locating the arteries, suturing them and applying subtle stitches to any prolapsed piles, so the instrument always remains in the same position while working through the small window, making the procedure extremely gentle and safe
• It does not cut or remove any haemorrhoidal tissue; hence post-operative complications are significantly reduced compared to haemorrhoidectomy
• Since the blood-supplying arteries aren’t tied off with rubber bands (as with haemorrhoid banding), but sutured, the THD procedure has been associated with far less post-operative complications and better long-term results
• Due to its low-recurrence rates compared to traditional types of surgery, the THD procedure has been adopted in numerous hospitals throughout Europe.

Recovery from THD

As the procedure is carried out in the area above the dentate line (an area without sensory nerves), you won’t feel any stitches during or after the procedure.

However, some patients may feel a slight discomfort in the rectal area afterwards, which usually disappears within a few days. If any prolapse has been sutured, some patients may feel a slight urge to defecate. This is related to the repaired prolapse and will gradually disappear as well.

In most cases, patients resume their normal activities within 24–48 hours.

C)The Rafaelo® procedure

This is a new and effective treatment significantly reduces and eliminates symptoms of internal haemorrhoids. It uses the established technology of radiofrequency ablation. This allows patients to return home on the same day of treatment with minimal post-operative pain, if any at all, and quickly return to normal daily activities

Who is the Rafaelo® procedure suitable for?

This procedure is ideally suited for patients with haemorrhoid grades 1–3. Some grade 4 haemorrhoids may be reduced but likely not to a complete resolution, which often will require surgery.

Suitable for patients experiencing:

• bleeding after passing a stool (the blood is usually bright red)
• itchy bottom
• a lump hanging down outside of the anus, which may need to be pushed back in after passing a stool
• a mucus discharge after passing a stool
• soreness, redness and swelling around your anus

What does the procedure involve?

The procedure is minimally invasive, and in most cases does not require a general anaesthetic and a number of patients have returned to their normal daily activities immediately after treatment.

• A local anaesthetic will be applied to the area of your haemorrhoid.
• The Device, emitting a safe and painless radio frequency energy, is then used to stem its blood supply and cause the haemorrhoid to contract.
• The procedure takes just a few minutes.
• In most cases, symptoms improve instantly.

How long is the recovery process?

Once the procedure is completed, most patients can return to their daily activities, but depending on the grade of their haemorrhoids post procedure recovery may take a little longer.

A number of patients have reported excellent results with little to no aftercare requirement.

D) Procedure for Prolapse and Haemorrhoids (PPH)

This operation is also known as stapled anopexy. A specially designed circular stapling instrument is inserted through the anus (back passage) into the rectum.

The operation pulls the swollen and prolapsing blood vessels of the haemorrhoids (piles) back into their normal position by removing a circumferential section (complete ring) of the internal rectal lining. The wound is inside the rectum causing little pain.

Why PPH?

Several studies have shown that the PPH operation is as effective as surgical removal of piles (haemorrhoidectomy) with the additional benefits of being associated with:

• Less post-operative pain
• A faster recovery time
• Shorter hospital stay
• Early return to normal activities and improved patient satisfaction

Do I need bowel preparation to empty my bowel before the procedure?

Yes. You are may be required to have an enema or be given suppositories to insert in your back passage to help empty your rectum before surgery.

Will I need to stay in hospital?

The PPH operation is usually performed as a day case procedure allowing you to return home the same day. Either a general or regional (epidural, spinal) anaesthesia is used. Your surgeon and anaesthetist will discuss these choices with you.

Are there any complications with this operation?

There are risks as with all operations. Approximately, 1 in 15 (5-8%) patients may have further piles in the future. The complications after PPH include:

• Pain
• Bleeding
• A persistent urgent need to go to the toilet with some leakage
• Narrowing of the back passage (stricture)
• Rarely severe pelvic infection
• Rarely, in females, fistula formation (tunnel/channel) between the rectum and vagina

What am I to expect, at home, after the operation?

Although the PPH operation is less painful than haemorrhoidectomy surgery, you may have discomfort within the back passage during the first few days after your operation. You will be given simple pain-relieving medicine, by your surgeon or a specialist nurse, to take when you are at home. You may have an urgent need to open your bowels even though there is nothing coming out. When you do go to the toilet there may be some bleeding though this usually stops within a few days.

What will happen to the staples?

The titanium staples used are very small; only a few millimetres long. Over a period of weeks and months some of them may pass during a bowel action. Most, though, remain at the operation site for ever. They will not cause difficulties and will not affect metal detectors during security check at airports.

When can I?

• Exercise: Almost immediately. Start with mild exercise and gradually build up to your normal activity levels over a period of a few weeks.
• Sex: Sexual intercourse may be uncomfortable for a week or two after surgery. It will not disturb the operation. However, you should avoid anal sex for around 6 months to prevent injury to partners and disruption of staple lines internally.
• Work: You should feel well enough to return to work within 7-10 days though this will depend on your type of job and your body’s healing rate.

If you have any concerns or feel unwell once home after the operation, you should either call your own doctor (GP) or the hospital. Your surgeon or a specialist nurse will give you hospital telephone contact numbers.

E) Haemorrhoidectomy

The excess tissue that is causing the bleeding is surgically removed. This can be done in under a spinal anaesthetic, or a general anaesthesia. This type of surgery is the most effective for completely removing piles, but there is a risk of complications.

What does the surgery involve?

A special device is used so that the surgeon can see the haemorrhoids. They are then removed by cutting them out. Most of the stitches are inside the anal canal and will dissolve over a period of two to four weeks. In most cases, the wound is left open to heal. The surgeon may also place a small pack inside the rectum to stop any bleeding. This will either be removed by the nursing staff, dissolve, or will be passed with your first bowel movement.

What are the risks?

Haemorrhoidectomy is a commonly performed operation and is generally a very safe procedure.

In approximately five in 100 cases, a post-operative bleed may occur. The bleeding often stops spontaneously but occasionally may need further surgery to correct it. Excessive bleeding may occur up to 14 days after surgery and this may result in being readmitted to hospital for observation or treatment.

Immediately after surgery you may also experience some difficulty in passing urine, but this should settle. Occasionally a catheter might be required to empty the bladder.

In rare instances the anus can become narrow and tighter making it difficult to pass stools comfortably. This is caused by shrinkage of the scar tissue.

A temporary leak of faeces or flatus may persist for several days after surgery The risks of surgery are assessed on an individual basis, as they can vary depending if you have any underlying health issues. Please discuss this with your consultant.

How long will I be in hospital?

Mostly this is a day case procedure you will be expected to go home on the day of your surgery.

What activities will I be able to do after my surgery?

You can return to normal physical and sexual activities when you feel comfortable.

How much pain can I expect?

At times the pain may be significant, so taking regular painkillers will help. Warm baths may also help reduce the discomfort. You may experience discomfort for up to four weeks after the operation.

Will I have a normal Bowel motion?

It is important to maintain a regular bowel movement that should be well formed but soft. Continue to take laxatives for two weeks after your surgery. Eating a high fibre diet and increasing your fluid intake will also help. You will normally open your bowels within two to three days of your operation although this may be uncomfortable at first. You may notice blood loss after each bowel movement but this will gradually reduce over the next few weeks. It is important to keep the operation site clean. If possible, wash after each bowel action for three to four weeks after the operation. Bathing once or twice a day is also soothing and may reduce discomfort. The cut area may take a month or more to heal properly and during this time there may be a slight discharge. Wearing a small pad inside your pants will protect your clothes from any staining.

When will I be able to drive?

You must not drive for at least 24 hours after surgery. Before driving you should ensure that you are able to perform an emergency stop, have the strength and capability to control the car and be able to respond quickly to any situation that may occur. Please be aware that driving whilst unfit may invalidate your insurance.

When can I return to work?

You can return to work as soon as you feel well enough. This could depend on type of work that you do. Typically, you will need one to three weeks off work.

Find out which haemorrhoid treatment is right for you by booking an appointment with Piles clinic UK.