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Treatment of piles: What are the options?

There are more than a dozen different approaches to dealing with haemorrhoids. In the first instance, it is best to use the most conservative approaches:

Creams, ointments and suppositories, which deal with symptoms, Venotonic therapies & Diet and lifestyle.

If conservative approaches do not resolve the problem, treatments fall into two categories—nonsurgical outpatient treatments and surgical treatments.

Non-surgical treatments include:

Banding, Sclerotherapy, Infrared coagulation, Bipolar diathermy, Radiofrequency, Electrotherapy,

Surgical treatments include:

Haemorrhoidectomy, Open Milligan-Morgan, Ferguson, Ligasure (coagulator-Medtronic), Stapling & Haemorrhoidal arterial ligation (THD or HALO)

Which approach to choose depends on the grade of haemorrhoids, your personal objectives and medical factors which may be relevant. An experienced consultant is recommended to help you make the right choice.

In considering treatments for piles, it is important to be aware of some overriding principles. First, no treatment will be successful for everyone. We are all different.

No treatment will be painless for all patients, and the perception of discomfort or pain can differ from one person to the next. However, the pain experienced varies from one treatment to another, as well as the duration of pain or discomfort

Even if a treatment is successful in removing your haemorrhoids, there is no guarantee that you will not suffer from haemorrhoids in future. This applies to all forms of treatment.

Some treatments may need to be done more than once in some cases to be fully effective. In considering such treatments, you need to balance this factor against other factors such as pain, discomfort, time off work or risk of complications.

The information below is restricted to treatments which have been used by the NHS in England in more than 1% of the cases treated.

Banding

Rubber band ligation, also called banding, involves the application of a tight elastic band around the base of the haemorrhoid which cuts off the blood supply and results in the haemorrhoid dropping off after typically 10-14 days.

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Surgical removal

Haemorrhoid surgery in the UK is an expanding field with increasing diversity. If other treatments haven’t worked or your haemorrhoids are not suitable for non-surgical procedures, then surgery for haemorrhoids may be an option. There are a number of procedures available, but the main ones are set out below. 

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Sclerotherapy treatment

In simple terms, sclerotherapy is the injection of a chemical solution into the area around the hemorrhoid resulting in a scarring reaction which makes the hemorrhoid gradually shrink or shrivel up over time. It is typically reserved for grades 1 and 2 internal hemorrhoids. 

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