Treatment of haemorrhoids

What is it?

Both techniques involve shrinking the swollen haemorrhoids. They are indicated particularly for limited internal haemorrhoids. In advanced cases, surgery is often indicated.

• Infrared coagulation is a medical procedure that uses infrared light. The infrared light will cauterise the swollen haemorrhoids. They shrivel as a result.
• Sclerotherapy injections involve injecting an irritant under the mucous membrane. This causes the swollen haemorrhoids to shrivel and the swelling to decrease.

Potential risks

These treatment methods are relatively painless and cause few side effects. Sometimes, multiple sessions are necessary to get the symptoms under control. They are performed by gastrointestinal specialists.

What is it?

In this technique, the troublesome haemorrhoids are grasped with a suction tube. A rubber band is then placed over the base of the haemorrhoid. The band cuts off the haemorrhoids. After 7 to 10 days, the haemorrhoid falls off with the excess mucous membrane, and disappears with the stool. The remaining scar causes some more shrinking and for that reason, there is usually no fast recurrence. Multiple bands can be placed during a single procedure. It is also possible to repeat the treatment later, if necessary.

Potential risks

• The main side effects of this treatment are limited pain and some urges (feeling like you need to go to the toilet). If mild painkillers (paracetamol) are not enough or the urge remains very severe, the rubber band sometimes needs to be removed.
• Because the area around the haemorrhoids has good blood supply, some blood loss may occur immediately after the procedure or when the haemorrhoid falls off. In case of significant blood loss, it is advisable to contact the surgery department or A&E.
• In case of fever, it is important to rule out local infection.
• In rare cases, urinary retention (difficulty emptying the bladder completely) may occur.

What is it?

Skin tag removal is sometimes advised for hygienic reasons.

• For smaller skin tags, this can be done under local anaesthetic at the 'minor surgery' outpatient clinic. This involves the minor discomfort of the injection for the local anaesthetic but apart from that, the procedure is usually very well tolerated.
• For larger tags, removal under a brief general anaesthetic is sometimes advisable.

Guidelines for at home

You may have anal wound pain for about two weeks after the procedure. This will be particularly noticeable during bowel movements. You may also experience some pain when the self-absorbing sutures are touched. If the sutures disappear at an early stage due to wiping, the wound may reopen partially. This sometimes causes some temporary loss of blood or pus. In some cases, it may be appropriate to apply a protective cream daily.

This technique, which has been available for a long time, used to be the only surgical option for serious haemorrhoids. The troublesome haemorrhoids are excised under general anaesthetic during this treatment. The remaining wound is either not sutured or only partially sutured. The wound will then gradually close by itself. Single haemorrhoids (monopolar resection) or multiple haemorrhoids (trefoil resection) can be removed in this way.

Although haemorrhoids rarely return after a haemorrhoidectomy, there are some drawbacks to the technique:

• most patients have quite a lot of anal pain during the first weeks after surgery, especially during bowel movements.
• loss of wound exudate over a prolonged period of time is possible too.
• because the healing wounds result in shrinking scars, this technique may cause anal stricture if multiple haemorrhoids are removed. For patients who only have a single large haemorrhoid, this treatment method is a good option.

This treatment is also known as the 'Longo procedure' or the 'Procedure for Prolapse and Hemorrhoids (PPH)'. It is intended for haemorrhoids that bulge all around and cause symptoms. This technique involves a special staple that is used to remove the swollen haemorrhoids. The healthy tissue that had been pushed outward is then pulled back in. This does not create open wounds, but it leaves a row of staples in the lower part of the intestine.

As there are no wounds, most patients have less pain and less loss of wound exudate after this procedure. Swelling of the staple row may make bowel movements somewhat laborious or fragmented during the first weeks. That improves by itself.

With this technique, a special device (a transanally inserted doppler probe) that works with ultrasound imaging, is inserted through the anus to find the blood vessels that supply the haemorrhoids with blood. These blood vessels are the reason haemorrhoids swell. Once these blood vessels are found, they are ligated to reduce swelling. In the THD procedure (which stands for 'Transanal Hemorroidal Dearterialisation'), bulging haemorrhoids can then also be 'sewn up' or put back into place.

This technique does not cause open wounds around the anus either. However, there may be considerable swelling in the anus in the first few days, resulting in difficult and painful bowel movements. This technique is less suitable for very extensive prolapsed haemorrhoids due to the higher risk of recurrence.

Usually stops on its own. If necessary, it may helpful to apply a covering pressure bandage. In rare cases, a second procedure is required to stop the bleeding. If in doubt, it is best to consult a physician.

Due to the procedure near the anus, you may have difficulty urinatingafter the procedure. You absolutely must have urinated before leaving the hospital. In exceptional cases, we will place a temporary bladder catheter.

As a result of the procedure, the tissue around the anus will be swollen. This may cause a sensation as if the haemorrhoids are still there (or partly there) when wiping. This swelling will disappear by itself in the first weeks after the operation.

Pain symptoms are normal after a haemorrhoids procedure. If the pain after the procedure gradually increases instead of decreases, then contact a physician.

If a patient develops a fever after the procedure, an infection must be ruled out. This may be a general infection (lung infection or urinary tract infection) but it could also be an infection in the operated area. Infections after surgery for haemorrhoids are rare, but they can be serious. Blood tests and potentially, targeted imaging will determine if antibiotics are required.

Bowel movements may be slightly difficult for a while after the procedure. Postoperative swelling may give you the sense that your bowel movements are obstructed. If this does not improve after a few weeks, it could indicate narrowing of the anus due to internal scarring. It may be necessary to stretch the wounds temporarily in the outpatients clinic (or under anaesthetic if this would be too painful).