Piles (Haemorrhoids) Treatment Options

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Piles (haemorrhoids) are swellings that develop inside and around the back passage (anus). Symptoms range from temporary and mild, to persistent and painful. In many cases, piles are small and symptoms settle down without treatment. If required, treatment is usually effective. There are various treatment options, detailed below.

Non-surgical treatments

 Lifestyle advice and medicinesRubber band ligationInjection sclerotherapyInfrared coagulation or photocoagulationBipolar diathermy and direct-current electrotherapy
Description

Make sure you have adequate dietary fibre in your diet and eat a balanced diet containing whole grains, fruits and vegetables. Drinking plenty of fluids is also very important to keep the stools soft.

Go to the toilet as soon as you feel the need and avoid straining when on the toilet.

Medicines for pain relief may be needed and topical creams and suppositories can help.

Banding is usually done by a surgeon in an outpatient clinic. A rubber band is placed at the base of the haemorrhoid. This cuts off the blood supply to the haemorrhoid which then dies and drops off after a few days. The tissue at the base of the haemorrhoid heals with some scar tissue. Up to three haemorrhoids may be treated at one time using this method.

Phenol in oil is injected into the tissues at the base of the haemorrhoids.

This causes scarring and the haemorrhoids then die and drop off.

This method uses infrared energy to burn and cut off the circulation to the haemorrhoid, which causes it to shrink in size.Uses heat energy to destroy the haemorrhoids.
Benefits

Often effective, and these measures will often ease symptoms such as bleeding and discomfort.

There are also general health benefits of eating a balanced diet with plenty of fibre and drinking plenty of fluids.

Banding of haemorrhoids is usually painless. In about 8 in 10 cases, the haemorrhoids are cured by this technique. Only a small number of people have complications following banding.Provides benefit for most people.It seems to be as effective as banding treatment and injection sclerotherapy.Appears to have similar success rates as infrared coagulation but is not widely used.
Risks

There are no side-effects but simple advice and initial treatment may be ineffective and so further treatments may be needed. 

Prolapsing haemorrhoids usually need further treatments.

In about 2 in 10 cases, the haemorrhoids come back at some stage. However, you can have a further banding treatment if this occurs.

Haemorrhoids are less likely to come back after banding if you do not become constipated and do not strain on the toilet.

Banding may cause pain for a day or two but otherwise doesn't usually cause any problems. Other complications may include bleeding, difficulty passing urine for a few days, or infection or ulcers forming at the site of a treated haemorrhoid.

Less effective than banding and not used for large prolapsing haemorrhoids.

Complications are uncommon but pain, bleeding and difficulty passing urine may occur for a few days and there is a risk of infection.

Infrared photocoagulation has been reported as causing fewer side-effects than other non-surgical treatments.The risk of any complications is low.

Surgical treatments

  
 Haemorrhoidectomy Stapled haemorrhoidopexyHaemorrhoidal artery ligation
DescriptionAn operation to cut away the haemorrhoid(s). About 1 in 10 people with haemorrhoids will eventually need surgical treatment. The operation is done under general anaesthetic.A stapling gun is used to cut out a circular section of the lining of the anal canal above the haemorrhoids. This makes the haemorrhoids shrink by reducing their blood supply.

The small arteries that supply blood to the haemorrhoids are tied (ligated). This causes the haemorrhoid(s) to shrink.

BenefitsMore effective in the long term than non-surgical treatment methods. Surgery usually cures haemorrhoids but the long-term success of surgery greatly depends on how well you are able to change your daily bowel habits to avoid constipation and straining.This is usually a less painful procedure than haemorrhoidectomy. It also allows a quicker return to work and other activities.This procedure is an effective alternative to conventional haemorrhoidectomy or stapled haemorrhoidopexy.
RisksCompared with non-surgical procedures, surgery is more likely to cause pain and other complications, and has a longer recovery period.

The back passage can be quite painful in the days following the operation. Other possible complications also include being unable to pass urine (urinary retention) during the first few days after the operation, bleeding (haemorrhage) during the first 10 days after the operation, and infection.

There is a higher rate of recurrence and need for further treatment compared with haemorrhoidectomy.

Complications are uncommon but may include bleeding and infection. Perforation of the rectum or causing a connection (fistula) between the rectum and the vagina or bladder are rare but serious complications.

Current evidence shows that there are no major safety concerns.

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Author:
Dr Colin Tidy
Peer Reviewer:
Dr Hayley Willacy
Document ID:
29390 (v1)
Last Checked:
06 March 2017
Next Review:
05 March 2020
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