Piles (haemorrhoids)

Surgery for haemorrhoids (piles)

Surgery may be recommended if other treatments for haemorrhoids (piles) haven't worked, or if you have haemorrhoids that aren't suitable for non-surgical treatment.

There are many different surgical procedures for piles. The main types of operation are described below.

Haemorrhoidectomy

A haemorrhoidectomy is an operation to remove haemorrhoids. It's usually carried out under general anaesthetic , which means you'll be unconscious during the procedure and won't feel any pain while it's carried out.

A conventional haemorrhoidectomy involves gently opening the anus so the haemorrhoids can be cut out. You'll need to take a week or so off work to recover.

You'll probably experience significant pain after the operation, but you will be given painkillers. You may still have pain a few weeks after the procedure, which can also be controlled with painkillers. Seek medical advice if you have pain that continues for longer.

After having a haemorrhoidectomy, there's around a 1 in 20 chance of the haemorrhoids returning, which is lower than with non-surgical treatments. Adopting or continuing a high-fibre diet after surgery is recommended to reduce this risk.

Haemorrhoidal artery ligation

Haemorrhoidal artery ligation is an operation to reduce the bloodflow to your haemorrhoids.

It's usually carried out under general anaesthetic and involves inserting a small Ultrasound scan probe into your anus. The probe produces high-frequency sound waves that allow the surgeon to locate the vessels supplying blood to the haemorrhoid.

Each blood vessel is stitched closed to block the blood supply to the haemorrhoid, which causesit to shrink over the following days and weeks. The stitches can also be used to reducehaemorrhoids that hang down from the anus (prolapsing).

The National Institute for Health and Care Excellence (NICE) recommends haemorrhoidal artery ligation as a safe andeffective alternative to a haemorrhoidectomy or stapled haemorrhoidopexy. It causes less pain and, in terms of results, a high level of satisfaction has been reported.

The recovery time after having haemorrhoidal artery ligation is also quickercompared with other surgical procedures. There's a low risk of bleeding, pain when passing stools, or the haemorrhoid becoming prolapsed after this procedure, but these usually improve within a few weeks.

Stapling

Stapling, also known as stapled haemorrhoidopexy, is an alternative to a conventional haemorrhoidectomy. It's sometimes used to treat prolapsed haemorrhoids and is carried out under general anaesthetic.

The procedure isn't carried out as often as it used to be because it has a slightly higher risk of serious complications than the alternative treatments available.

During the operation, part of the anorectumthe last section of the large intestineis stapled. This means the haemorrhoids are less likely to prolapse. It alsoreduces the supply of blood to the haemorrhoids, which causes them to gradually shrink.

Stapling has a shorter recovery time than a traditional haemorrhoidectomy, and you can probably return to work about a week afterwards. It also tends to be a less painful procedure.

However, after stapling, more people experience another prolapsed haemorrhoid compared with having a haemorrhoidectomy.

There have also been a very small number of serious complications after the stapling procedure, such as fistula to vagina in women, where a small channel develops between the anal canal and the vagina, or rectal perforation, where a hole develops in the rectum.

Other treatments

Other treatment options are available, including freezing and laser treatment. However, the number of NHS or private surgeons who perform these treatments is limited.

General risks of haemorrhoid surgery

Although the risk of serious problems is small, complications can occasionally occur after haemorrhoid surgery.

These can include:

bleeding or passing blood clots ,whichmay happen a week or so after the operation
infection, whichmay lead to a build-up of pus (an abscess ) you may be given a short course of antibiotics after surgery to reduce this risk
difficulty emptying your bladder (urinary retention)
the involuntary passing of stools (faecal incontinence)
a small channel that develops between the anal canal and surface of the skin, near the anus (anal fistula)
narrowing of the anal canal (stenosis) this risk is highest if you have treatment on haemorrhoids that have developed in a ring around the lining of the anal canal

These problems canoften be treated with medication or more surgery. Ask your surgeon to explain the risks in more detail before deciding to have surgery.