Haemorrhoid Treatment

Haemorrhoids (also known as ‘piles’) are swollen cushions of blood vessels around or just inside the anal canal (back passage). There are two kinds of a haemorrhoid: internal and external.

These haemorrhoidal cushions are normal anatomical structures but are made to swell and balloon by straining on the toilet, pregnancy, heavy lifting, family history, overweight that then cause bleeding, itching and soreness, discomfort, mucous discharge and protrusion through the anus.

Consultation/Protoscopy:

• You will be greeted by our friendly staff and have a chaperone allocated to you.
• You will then have a full clinical assessment with Mr von Roon who is a leading London teaching hospital colorectal surgeon.
• He will perform clinical examination including a proctoscopy, where a small plastic telescope is inserted into the back passage to confirm a diagnosis.
• Once a diagnosis is made he advise you whether your haemorrhoids are suitable for treatment and discuss the treatment options with you. You can then decide when to schedule treatment

Banding/Ligation procedure:

• A band is placed tightly around the haemorrhoid.
• This only takes a few minutes and doesn’t generally require local anaesthetic.

The Rafaelo procedure:

• Takes about 10-20 minutes and is performed under local anaesthetic
• You will be reviewed at 4 weeks once it has taken time to fully resolve.

All treatments and procedures have risks. The most common risks post-procedure and during the following 2 weeks include discomfort, mild bleeding or spotting or anal discharge and faecal urgency in the first 48 hours. Other rarer post-procedure complications might include recurrence of symptoms, infection, ulceration, fissure, or significant bleeding/haemorrhage.

Your consultant will discuss the benefits and risks of The Rafaelo Procedure during your initial consultation.

If this is the case the best option is to treat the haemorrhoids first as these are the cause of the anal skin tags.

By undergoing the Rafaelo treatment, this will not only help prevent this from happening again but may also improve the anal skin tags by causing the tissue internally to contract and pull up some of the excess skin.

If after 2 months there is still residual skin then you can opt to have this removed under local anaesthetic by our cosmetic doctors and plastic surgeons.

Take 2 tablets (1000 mg) of paracetamol every 4 to 6 hours. If this is not sufficient, add in 2 tablets (400 mg) of ibuprofen every 4 to 6 hours. You can take both painkillers together safely. Some people have contraindications to ibuprofen – check with Mr von Roon on the day or with your doctor or pharmacist. If the pain is uncontrolled with above please contact Mr von Roon.

Lifestyle changes to diet, to increase oral fluid and fibre intake thereby softening the stool will help reduce straining avoiding straining and avoiding strenuous lifting.

Treatment options are radiofrequency (Rafaelo), ligation (rubber banding) and injections. These are carried out as outpatient day cases under local anaesthetic. For more extensive haemorrhoids surgical removal under general anaesthetic is required.

The consultation and treatment take place at 41 Harley Street, London W1G 8QH. The clinic is registered with the CQC (Care Quality Commission) with an inspection report in August 2019 passing it as good.

You will be able to open your bowels normally. This should not be more painful than normal. As mentioned above, you may experience the urgency of defaecation.

Most people are able to work the following day. However, if you get urgency this can be a little unpredictable, so if you have the option of working from home, it is advisable to do this on the first day.

As the Rafaelo procedure is a novel treatment and the evidence base for it is still being established, the National Institute for Health and Clinical Excellence (NICE) has recommended that it should be used with special arrangements for clinical governance, consent and audit.

At Cosmedics, we keep careful records of all Rafaelo cases performed and regularly audit our clinical outcomes for the procedure.

Yes, both rubber ligation (banding) or injection of sclerosant (Phenol) is an option should Rafaelo radio-frequency not be appropriate or surgery in severe cases.

On assessment, your colorectal consultant will discuss the best options for your haemorrhoid treatment.

Anal skin tags are caused by the swelling of the pile or haemorrhoid externally causing the skin to stretch. Once the haemorrhoid shrinks people can often be left with anal skin tags. These anal skin tags can be treated by us separately, but you need a surgeon assessment to ideally diagnose what is the true cause of anal skin swelling.

Key symptoms on opening bowels

• Swelling of skin tag = skin tag and haemorrhoid
• Bleeding and sharp pain that lasts for few hours = fissure (tear in anal skin)
• Bleeding and minimal if any discomfort = haemorrhoid

We find that in practice, 9 out of 10 people are very satisfied with the outcome of the procedure for treating haemorrhoids.

One in 10 feel that their haemorrhoid symptoms are not improved sufficiently afterwards. In these cases, the Rafaelo procedure can be repeated, or an alternative treatment like excision of remaining anal skin tags or traditional haemorrhoidectomy may be required.

Mr von Roon will advise you on this when you attend for the follow-up consultation after your haemorrhoid treatment.

You can eat as normal before and after. There is NO need for an enema (clearing out of bowels with laxative).

We advise that you increase the amount of fibre in your diet and your fluid intake in the first two weeks after the procedure to avoid constipation.

Yes, it is a common occurrence to have haemorrhoids in homosexual men.

It can be very embarrassing and awkward to have haemorrhoid symptoms. There is also the sexual health risk to consider due to the increased likelihood of bleeding during intercourse with haemorrhoids.

Haemorrhoid treatment is ideal for patients who just want to get back to normal daily lives as quickly as possible and not have to worry about it again.

For exercise such as running, swimming and cycling and strenuous activities resume as normal after 2 weeks.