Has anyone had the Hal-Rar Surgery for grade 4 hemorrhoids / bleeding Piles?

Hi not heared of that surgery, i have done everything they told me but it is still sore after 4months

Hi Annie I’m in Australia and a operating nurse 

I havent heard of that operation being done here unless they call it something different? 

Can your dr just band the haemorrhoids or are they progressed to grade 3-4 ?! 

You can always pay privately and have it done in a private hosp.   You would be looking at around $2000... 

A year is a long time to wait with these awful things 

Good luck xx

The HAL-RAR is also called the HALO treatment for hemorrhoids. Here is the link http://haemorrhoidinfoservice.com.au

Hi Annie, I underwent the HAL-RAR procedure late last year. I was suffering a combination of Grade 3 and Grade 4 haemmoroids and a chronic fissure that had developed over several months due to the haemorrhoids. Needless to say, it was extremely painful to the point that I had to endure excruciating pain after a bowel movement (BM) and was forced to lay on a bed/flat surface for a good 15-20 minute in order to subside the pain.

This was unbearable so I decide to undergo the HAL-RAR treatment (with Botox to treat my fissure). The results were excellent. The surgery was was performed in under an hour with general aesthetic and I was back home the same day.

The procedure itself is painless, and in the hours immediately following the surgery (once the anaesthesia begins to wear off), I only felt a slight nudging sensation in my buttocks - no severe pain whatsoever.

Here is a summary of my personal experience after the procedure:

Day 1 post-surgery: very mild pain, no BM, only needed to take mild pain-killer (equivalent to over-the-counter ibuprofen or strong paracetamol), soft diet - e.g. mashed potatoes, bananas, rice, mashed pumpkin, soups, etc. (strictly NO fibre for at least a few days post-surgery and NO processed foods for at least 1-2 weeks). Very sore thighs and buttocks (feeling akin to that of post-workout session at the gym).

Day 2: as above, some mild pain in rectum when moving about such as going to the loo - my surgeon advised me to take bed-rest for at least 2-3 days post-surgery so I complied. Still no BM. Soft, liquid diet. Mild pain-killers consumed to control pain.

Day 3: as above, first BM post-surgery. Mild pain during BM experienced (around 2-3 out of 10, where as the pain was about 9 out of 10 before the procedure). BM took about 5 minutes without ANY straining at all, where as before it use to take me 40-50 minutes and a lot of straining. Warm shower immediately following the BM subsided the mild pain. I took the same mild pain-killers to manage the pain during the day. Same soft liquid diet.

Day 4-7: as above, subsequent BM were almost pain-free! Mild pain post-BM was being easily managed by ibuprofen/paracetamol. Still on a soft liquid diet (this was significantly helping the BM at it would keep the stools very soft and easy to pass).

Week 2 post-surgery: very little pain post-BM (almost like a pulsating sensation rather than 'pain' as such). Stopped taking pain-killers (only took when required). Started to slowly consume fibre (around 1 tsp twice per day of psyllium husk). Started eating solid food - mainly fruits and vegetables - but still NO proceeded foods. Resumed work. Mild pain during the day. As the days passed, the pain subsided to the point that it was almost insignificant.

Week 3: normal BMs - no pain during BM and most of the time, no pain after. On the days where there was pain, it was merely a throbbing sensation (severity 0.5-1 out of 10). No pain-killers at all. Solid foods - avoided processed foods. High-fibre diet (2-3 twice per day of psyllium husk). Resumed non-streneous activity and exercise (walking/jogging).

Week 4: BM pain-free 99% of the time. No pain post-BM. Normal foods. No medication. High-fibre diet continued. Exercise and non-streneous activities continued.

1 Month post-surgery: living life as 'normal' once more. Sometimes, I would get minor short-lasting 'sharp' pains during the BM and this was because my fissure was still healing - the haemorrhoids, however, were not the cause of the pain. High-fibre diet and moderate non-streneous exercise continued. Avoided processed foods wherever possible.

2 Months: as above, conditions only got better. Pain severity during and after BM (if any, 0.5/10).

3 Months: conditions ameliorated further. Again, some days where I would get sharp pain during BM that was again at attributed to my healing fissure. These pains would subside over 1-2 days and were hardly causing me any distress. Pain severity during and after BM (if any, 0.1/10).

4 Months: conditions ameliorated further. I consulted my surgeon for a check-up and was told my haemmoroids were pretty much back to their 'normal' size, thus healed, and my fissure was also almost fully-healed. Some scar tissues and 2 skin-tags were residual remnants of the procedure. However, they were not causing me any distress so I decided against having them removed.

4 Months-present: BM are pain-free. It is very rare that I experience any pain at all these days. Sometimes I can 'feel' my stools exiting the bowels that perhaps a person who has not had surgery would not. It is a strange sensation but it is not 'pain' as such. I eat a high-fibre, low-carb, med-high protein diet. I drink plenty of water during the day. I consume alcohol about once per fortnight. No medication for pain (since I experience none). Living a 'normal' lifestyle after almost 3+ years.

My recommendation: if you are experiencing severe pain that is interrupting or degrading your lifestyle, and your condition does not seem to improve even after tyring all natural therapies, including changes in diet, water intake, or exercise, then I would strongly advocate the HAL-RAR procedure as a long-term treatment/solution for your haemmoroids.

I hope that helps you with your decision. I understand your pain and suffering as I myself was in that position not too long ago. Do not delay the procedure due to fear of pain. The long-term benefits of having the surgery done significantly outweigh any negative effects, which are short-term anyhow.

Ensure you undertake the surgery with a reputable surgeon (protosurgeon) at a reputable hospital. The surgery will set you back around $2,000 if you have private health insurance. This is a small sum to pay compared to ensuring the pain and suffering of having Grade 3 and 4 haemmoroids and a chronic fissure on a daily basis.

Wishing you all the best. Please feel free to ask any questions. I will try my best to assist! Take care

P.S. I live in Sydney and had my surgery (HAL-RAR) here.

Hi Annie,

did you end up having the halrar surgery? I've just had it done 4 days ago I first developed hemorroids when i was pregnant 20 years ago. Over the years they kept getting worse but i was too scared to get the traditional surgery. I kept losing a lot of blood and became severely anaemic where i was having iron infusions every six months On top of all my problems is that i suffer from IBS so am regularly constipated. This year they progressed to grade 3 and 4 prolapsed ones and were becoming regularly painful, so i made the decision to do something and did some research. My GP had never heard of it but i found a surgeon near me that i could get a referral to. It was very hard to find out if he was any good so just had to have trust. He told me that he was training other surgeons in Victoria and had done more than anyone else.

SURGERY DAY: had to fast from 8 am and had the surgery around 4.30 pm Woke up extremely nauseous and quite agitated, felt like I'd been kicked in the bum. Couldn't stomach any food and was on strong pain killers, antibiotics and anti-nausea medication.. Stayed overnight in the hospital.

DAY 1 POST OP: woke very nauseous, barely ate breakfast which was All Bran cereal. Managed half a sandwich around 3 pm and felt okay enough to travel the 20 minutes home., although they were willing to let me stay another night but i just wanted to go home.

DAY 2 POST OP: still no BM, am dreading it. Was advised to take lactulose if constipated. Not sure if constipated as I've barely eaten anything but take 20 mls around lunchtime Am still on strong pain killers, anti nausea meds and antibiotics, force myself to have tomato soup.

DAY 3 POST OP: still no BM, advised to take more lactulose. Have 1 scrambled egg for breakfast, have a little bit of salad for lunch and pumpkin soup for dinner. Try to get up and walk around a bit when i can. Finally a BM, the pain is excruciating, i feel like I'm going to pass out and the BM is tiny. An hour later another BM, more this time but it feels good, an hour later another BM, more explosive, then half an hour later another one, have now had 5 BMs in about 4 hours The last one was painful, have taken panadol extra and using a heatbag Each time I have a BM I have a sitz bath, found one online. Am still in pain now an hour later, I hope tomorrow is better ...