Haemorrhoids (piles) - Surgery for piles (haemorrhoids)

Surgery may be recommended if other treatments for piles (haemorrhoids) have not been successful, or if you have haemorrhoids that are not 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 is usually carried out under general anaesthetic, which means you will be asleep during the procedure and won't feel any pain while it is carried out.

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

You will 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 is 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.

Transanal haemorrhoidal dearterialisation (THD) or haemorrhoidal artery ligation (HALO)

Transanal haemorrhoidal dearterialisation (THD) or haemorrhoidal artery ligation (HALO) is an operation to reduce the blood flow to your haemorrhoids.

It's usually carried out under general anaesthetic and involves inserting a small device, which has a Doppler ultrasound probe attached, into your anus. This probe produces high-frequency sound waves that allow the surgeon to locate the blood vessels in and around your anal canal. These blood vessels supply blood to the haemorrhoid.

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

The National Institute for Health and Care Excellence (NICE) recommends this treatment as an effective alternative to a haemorrhoidectomy or stapled haemorrhoidopexy (see below). The procedure causes less pain and, in terms of results, a high level of satisfaction has been reported. Most people are able to return to their normal activities much sooner than with other surgical procedures.

There is 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 is sometimes used to treat prolapsed haemorrhoids and is carried out under general anaesthetic.

This procedure is not carried out as often as it used to, because it has a slightly higher risk of serious complications than the alternative treatments available.

During the operation, part of the anorectum (the last section of the large intestine), is stapled. This means the haemorrhoids are less likely to prolapse and it reduces 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 will usually be able to 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 following 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, which may occur a week or so after the operation
• infection, which may lead to a build-up of pus (an abscess) – you may be given a short course of antibiotics after surgery to reduce this risk
• urinary retention (difficulty emptying your bladder)
• faecal incontinence (the involuntarily passing of stools) 
• anal fistula (a small channel that develops between the anal canal and surface of the skin, near the anus)
• stenosis (narrowing of the anal canal) – 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 can often be treated with medication or further surgery. Ask your surgeon to explain the risks in more detail before deciding to have surgery.

When to seek medical advice

Seek medical advice from the hospital unit where the surgery was carried out, or from your GP, if you experience:

• excessive bleeding
• a high temperature (fever)
• problems urinating
• worsening pain or swelling around your anus

If you are unable to contact the hospital or your GP, call NHS 111 for advice or visit your nearest accident and emergency (A&E) department.