Haemorrhoids are enlarged blood-filled spaces within the anal canal. They are commonly thought of, incorrectly, being like varicose veins of the bottom. The most common symptom of haemorrhoids is bleeding, which is typically bright red fresh-looking blood. Other common symptoms are itchiness and and a feeling of something coming down when opening your bowels (prolapse).
It is important to exclude other, more sinister, causes of bleeding when assessing someone with haemorrhoids and it is common practice to arrange for a flexible endoscopy to assess the bowel.
There are a number of treatment options for haemorrhoids:
Rubber band ligation of haemorrhoids
This is a simple outpatient procedure that can be performed at the time of a clinic consultation. A special suction device is used to draw the haemorrhoid up and a tiny rubber band is deployed over the base of the haemorrhoid. This strangulates the haemorrhoid causing it to slough away, akin to docking a lamb’s tail. The procedure is generally very well tolerated and can be repeated if necessary.
Haemorrhoidal artery ligation
The haemorrhoidal artery ligation operation (HALO) or transanal haemorrhoidal de-arterialisation (THD) procedures both work in a similar way. Under a general anaesthetic a probe is inserted in through the anus to identify the blood vessels that are supplying the haemorrhoids. These can then be tied off with a suture, causing the haemorrhoids to shrink away. If the haemorrhoids have been prolapsing, an additional suture can be placed on the surface of the haemorrhoid to draw it back up internally. This is known as a recto-anal repair.
This procedure is generally well tolerated, with patients experiencing mild to moderate discomfort post-operatively. It can normally be undertaken as a day case and achieves good rates of symptomatic improvement.
Haemorrhoidectomy involves surgically cutting out the symptomatic haemorrhoids. This is performed under a general anaesthetic and can be undertaken as a day case or with an overnight stay. This operation is particularly effective for bulky haemorrhoids that tend to prolapse most of the time. However, it is usually regarded as the most painful of the treatment options, although by 10 days to 2 weeks post operatively, this has largely subsided.