Treatment of haemorrhoids
When to have non-surgical treatment?
When to have non-surgical treatment?In the first instance, all patients with haemorrhoids are advised to follow a certain lifestyle regimen. In some cases, these measures can clearly reduce the symptoms or even eliminate them altogether. If haemorrhoids do continue to cause symptoms, other measures are appropriate. There are three different non-surgical techniques for treating symptomatic 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.
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.
When to have surgical treatment?
When to have surgical treatment?If haemorrhoids do not respond or insufficiently respond to non-surgical treatments, a more drastic treatment may be necessary. There are several options for that too.
In our hospital, we choose from several techniques based on the type of haemorrhoids, the type of symptoms and some patient-specific characteristics.
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.
Course of the procedure
Preparation
These procedures are usually performed in the day hospital and you do not have to stay overnight in the hospital. If you are in too much pain or if there are problems immediately after the procedure (such as blood loss or urinary retention (difficulty/inability to urinate)), an overnight stay may be needed.
On the morning of the procedure, go to the Admission Department having fasted.
Type of food: Example: Allowed until at the latest: Normal meal midnight before the surgery or examination Light meal e.g. a sandwich or toast with jam. Deep-fried/fatty foods or meat are not included six hours prior to the procedure or examination Dairy products Milk, bottle-feeding for a child, yogurt... six hours prior to the procedure or exam Breastfeeding four hours prior to the procedure or examination Drinks As wished: water, sugar water, sports drinks, clear fruit juices without pulp (apple juice, grape juice)
Maximum a cup: clear tea and coffee without milk
.Recommended: continue to drink up to two hours before the procedure or examination
(Exceptions: gastrointestinal surgery. You should follow the instructions of your attending physician).
No milk products
Specific preparation is usually not necessary. There is no need to administer an enema for intestinal irrigation beforehand. If this is required however, your physician will inform you of this in advance.
Aftercare
- At the end of the surgical procedure, an anal compress is often inserted. These compresses must not be removed, they will disappear by themselves with the first bowel movement. After stapling the haemorrhoids, your physician will usually insert a larger bandage to prevent bleeding in the first post-operative hours. Your ward nurse should remove this a few hours after the procedure.
- Before your discharge, the attending physician or assistant will explain pain relief and suitable wound care to you on the ward. In some cases, it is appropriate to apply ointment locally . You will be informed at the time of your discharge. You will be given the necessary prescriptions and a letter for theGP. Sometimes, a certificate for home nursing care is required.
- Due to the presence of wounds in or around the anus, bowel movements may be painful initially. Try to avoid constipation by drinking enough fluids and eating enough fibre. If necessary, laxatives will be advised for the time being. If the stool becomes too liquid, you can obviously interrupt the treatment.
- A check-up in the outpatients clinic is scheduled for three weeks after the procedure. Pain is usually well controlled by then; the wounds may sometimes take up to six weeks to heal. If necessary a follow-up appointment is planned. Despite the proper treatment, haemorrhoids may cause problems again after months or years. Try to prevent this by following the lifestyle regimen.
- Afterwards, it is best to take account of the general measures/living rules.
Potential risks
Every operation is associated with a risk of a number of general complications. In procedures for haemorrhoids, this risk is very low, as the anaesthetic is very brief. However, a number of specific complications are possible:
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).
Centres and specialist areas
Centres and specialist areas
Latest publication date: 16/05/2024
