Type of treatment for haemorrhoids depends on the severity and frequency of symptoms, as well as the type and size of the haemorrhoids itself. There are other considerations such as patient’s general medical history and medication.
Treatment of haemorrhoids all consists non-surgical treatments that aims to reduce straining and pressure on haemorrhoids. This includes increasing the bulk of stools and prevent constipation. It also involves developing good toilet habits that avoids staining and increased pressure on the haemorrhoids.
Various surgical treatment for haemorrhoids are available and your surgeon will advice you on the best surgical options for your condition. Some of the treatment options can be performed with local anaesthetic but some more complex treatment options may require general anaesthesia.
Injection Sclerotherapy
This is most effective for small internal haemorrhoids that bleed. A chemical “sclerosant” is injected under the lining of the rectum, causing the blood vessels in the haemorrhoids to shrink and shrivel.
It is performed with or without local anaesthetics, using a tube and light (proctoscope) to see inside the anus. It is not usually painful as there are no pain receptors in the internal haemorrhoids.
Some bleeding may occur for a few days after the procedure and it usually resolves by itself. Occasionally, the injection procedure may have to be repeated if symptoms persists.
Rarely, the injected oil causes an inflammatory response that causes pain and fever. Impotence in male has been reported following damage to nerves near the prostate gland, but this is very rare.
Rubberband Ligation
This is effective for small to medium size internal haemorrhoids that bleed or have minor prolapse. It is performed with or without local anaesthetic, using a tube and light (proctoscope) to see inside the anus. The haemorrhoids is grasped by a special instrument (or using a suction device) and a rubber band is placed around the base of the haemorrhoids. Multiple rubber bands are usually placed in a single treatment. The band constricts the blood supply to the haemorrhoids resulting in separation of the haemorrhoids. It may need to be repeated if symptoms persists.
Banding often produce mild discomfort in the anal region. Patient often reports the sensation of needing to defaecate. It is important not to strain despite the sensation of incomplete emptying in the few days after the procedure. Far majority of patient are able to return to normal activities the day after the procedure. Pain is rare and if severe, the rubber band may need to be removed.
There may be small amount of bleeding in the few days after the banding which is normal. Small amount of bleeding may occur about 7 to 10 days after the procedure when the haemorrhoids falls off. You may need to wear a pad if bleeding occurs. Significant bleeding is uncommon and you should seek urgent medical attention if it does occur. Significant bleeding is uncommon and surgical intervention is rarely required. It usually stops by itself but blood transfusion is required in rare cases.
Pelvic infection is rare but can be life-threatening. Urgent medical attention is required.
Haemorrhoidectomy (Surgical Excision)
This treatment is most effective for large haemorrhoids, especially if there are significant prolapse.
It involves surgical removal of the haemorrhoid tissue and some associated skin. Haemorrhoid tissue is careful dissected away from anal sphincter muscles and excised using diathermy or other form of surgical coagulation. The subsequent wound is usually left open to heal.
The procedure is performed under general anaesthesia and require overnight stay in hospital.
Haermorrhoidectomy involves removing part of the skin as well as haemorrhoid tissues, it does involve significant pain around the anal region for two to four weeks. This is managed with pain relief medications. Patients will also be prescribed stool softeners to prevent constipation. Oral antibiotics may also be prescribed.
Small amount of bleeding can occur and it may be necessary to wear a pad. Warm salt bath or shower, especially after passing bowel motion, may reduce discomfort. The area should be kept clean and dried gently. Some patient find hairdryer may be useful in keeping the area dry.
Urinary retention (inability to pass urine) can occasionally occur after anal surgery.
Rarely, infection may develop and can lead to bleeding about 10 day after the surgery. It can be quite significant and may become life-threatening. Urgent medical attention is required if significant bleeding occurs.
Anal fissure (anal ulcer) is a rare complication that may result from failure of one of the haemorrhoidectomy wound to heal completely.
Anal stenosis (narrowing of the anal canal) is a very rare complication and can occur especially if large amount of haemorrhoid tissue is removed. Extreme care is taken if the haemorrhoid is especially large not to remove too much tissue. Occasionally, only part of the haemorrhoid tissue is removed and the procedure is repeated once the healing process is complete.