Treating haemorrhoids (piles)

An introduction to haemorrhoids: what they are, how they're caused, and how they can be prevented and treated.

Mo Saeed consulting

Investigation of Haemorrhoids

Treatment of early Haemorrhoids (grade 1 and 2)

Dependent on the severity of haemorrhoids, symptoms arising from very early haemorrhoids can be treated by adopting a high fibre diet. If symptoms donít resolve then banding or injection of the haemorrhoids may be advised.

1. Banding of haemorrhoids

This treatment works by a rubber band cutting through tissue and causing an ulcer which heals by fibrosis, "fixing" the haemorrhoid in its normal anatomical position.


2. Injection Sclerotherapy

The rational of injecting chemical agents into haemorrhoids is to create fibrosis so that prolapse cannot occur.


Treatment of advanced Haemorrhoids (grade 3 and 4)

1. Haemorrhoidectomy

This is a radical surgical treatment for grade 3 and 4 haemorrhoids and is performed under general or spinal anaesthetic. The operation involves cutting out the haemorrhoids and is an effective treatment but is associated with considerable pain on opening bowels on the first few occasions. Pain can sometimes persist for several weeks.


2. Stapled Haemorrhoidectomy

This technique involves the removal of excess prolapsing tissue above the haemorrhoids resulting in the restoration of the haemorrhoids to their normal anatomical position.

3. Haemorrhoidal Artery Ligation Operation (HALO)

A relatively new technique first devised by a Japanese surgeon in 1995 and now becoming increasingly popular in various parts of the world.

The HALO procedure Mr Saeed performing the HALO procedure

The basis of the operation is to restore the haemorrhoids back to their anatomical position, and occlude the blood supply to the vascular cushions forming the haemorrhoids, resulting in them shrinking. The operation is best performed under general or spinal anaesthesia. However smaller haemorrhoids in some patients can be treated under sedation and local anaesthesia using this technique.

A miniature Doppler ultrasound device locates branches of arteries supplying the haemorrhoids. These blood vessels are tied off, and the haemorrhoid shrinks over the subsequent days and weeks.

Cast of a haemorrhoid This cast of a haemorrhoid clearly shows the feeding artery (white arrow) which is carefully located with this procedure

Because the stitch is placed in the lower rectum where there are virtually no sensory nerves the procedure is pain-free.

View a PowerPoint slide showing a diagram of the HALO procedure

New developments to this technique now means that in addition, an Anopexy to return the prolapsing haemorrhoids back into rectum can now be performed.