Advice centre / Treating haemorrhoids / Different treatments

Non-surgical haemorrhoid treatments

Lower risk treatments with differing technologies

What does non-surgical mean?

eXroid® uniquely offers the lowest risk procedure suitable for all 4 grades of haemorrhoids. There are also other non-surgical alternatives available that can be carried out in an out-patient environment, meaning less down-time, lower risk of complications and better convenience for many patients. Each treatment is unique, including grades it can be used on, level of risk & recovery needed and need for local anaesthetic. Banding is one of the most commonly known of these. Read about some of the alternative treatments here.

Electrotherapy

Haemorrhoid electrotherapy has been scientifically researched as a treatment for piles for over 150 years. It’s only recently that advances in medical technology have enabled the treatment to become a mainstream clinical practice. The procedure is exclusively used for the treatment of internal piles, which provides an option for patients with grade 1 or 2 haemorrhoids who may otherwise have opted for banding or sclerotherapy or for patients with more severe grade 3 or 4 haemorrhoids as an alternative to surgery.

The main benefits of the treatment for haemorrhoids is it’s safety and convenience, which is demonstrated in the fact that over 90% of our patients are able to go about their normal duties on the same day. Electrotherapy is still relatively new to the UK, but has been approved by NICE and it has already proven to be a preferable treatment alternative to some of the more well-known haemorrhoid treatments for our patients, may of which choose us.

What does eXroid® electrotherapy treatment involve?

The procedure is carried out with the patient lying on their side, with their knees slightly bent. Whilst in this position a proctoscope (a small plastic tube) is inserted into the patient’s bottom to enable a clear view of the haemorrhoid(s).

A thin probe with metal contacts is then inserted down the proctoscope and placed at the base of the haemorrhoid to be treated, at which point a low-level electric current is delivered. This causes chemical cauterisation and thrombosis of the blood vessels feeding into the haemorrhoid; this is not a burning process.

The low-level electric current is controlled by a hand piece connected to the probe which enables the specialist to increase or decrease the current dependent on the tolerance of the patient.

The duration of the treatment depends on the grade of haemorrhoid and the current delivered.

eXroid® electrotherapy for haemorrhoids is an outpatient treatment and requires no anaesthetic.

Is low current effective for piles?

eXroid® electrotherapy is a highly effective treatment for piles.

Half of patients were cleared of their haemorrhoid after one treatment session, and over 80% after two. Larger piles may require more than two treatments.

The number of treatments you need largely depends on how many piles you have, and how big they are.

Is the procedure painful?

The eXroid treatment itself is not usually associated with significant pain relating to the current delivered, however, some patients do find the process painful relating to the insertion of the anoscope (a hollow plastic tube) to allow access to the base of the internal haemorrhoids, where the eXroid treatment site is. There are usually very few nerves at this point (well above the dentate line) so pain is not usually experienced, rather a dull aching sensation has been described by patients. The intensity of this ache can be managed by the treating doctor by adjusting the current to a tolerable level for the duration of the treatment and the doctor will talk to you during to manage this to suit you as well as get the best possible result.

Occasionally, during the treatment, the muscular anal canal can go into spasm (a bit like a cramp pain) as the body tries to push out the anoscope. Using relaxation techniques, guided by the treating doctor, can help patients to relax during the treatment which can ease this discomfort. For most patients the treatment is not painful, but for about 10% of patients (based on patient feedback data) it can be more unpleasant and/or painful. However, our eXroid Practitioners can help find a solution to manage any pain or discomfort using various techniques during the treatment process and will tailor the treatment to the individual needs.

eXroid® electrotherapy after treatment

In most cases you will notice the haemorrhoids / piles continuing to shrink after treatment. This will usually continue for up to 4 weeks after treatment and your symptoms will normally diminish.

NICE evaluation and evidence base

After noting its effectiveness and low complication rate, NICE published positive guidance for electrotherapy hemorrhoid treatment through Interventional Procedure Guidance (IPG) 525 in June 2015.

Haemorrhoid electrotherapy may require more than one treatment; however, about half of the patients treated are free of symptoms after one treatment session, and over 80% after two.

Patients with more numerous and/or larger haemorrhoids may need more than three treatments to get complete relief. Electrotherapy for haemorrhoids causes less discomfort and less side effects than generally reported figures in the literature compared with banding or higher current electrotherapy, which suggests that it is likely to be one of the best tolerated non-surgical procedures available.

Are there any risks with piles electrotherapy treatment?

Please note that no treatment for haemorrhoids is 100% safe or 100% effective for all patients, and eXroid® is no exception— there are some risks with even the safest and most effective treatment.

Rectal bleeding can be a side effect, but this is usually short lived. Following treatment, there may be bleeding from the bottom, which is more likely if there has been recent bleeding from the piles. Some patients will experience sensitivity of the skin on their left hip for up to 48 hours following treatment, where the saline soaked Sponge pad rests during the eXroid treatment. Other side effects and complications are very rare or have not been reported, but could include more prolonged discomfort or pain, an external thrombosed pile, infections, scarring, strictures or perforation of the bowel.

Based on the patients who’ve shared their experience following our treatment, most reported a return to normal activities immediately and 90% reported a return to normal activities on the same day. Where there is any post treatment pain it is usually eased with simple OTC analgesics such as paracetamol. The procedure has been proven to be virtually complication free.

Complimentary and comparative options for treating haemorrhoid disease

There are a number of treatment options for patients to consider.

Historically these have been segmented by the progressive grade of haemorrhoid disease as traditionally there has not been a viable single option that has treated all grades of haemorrhoids prior to the eXroid® treatment.

To organise an appointment with an eXroid consultant, please call us on 0800 999 3777 or click here for all other queries.

Haemorrhoid Banding

What is haemorrhoid banding?

Rubber band ligation, also called banding, involves the application of a tight elastic band around the base of the haemorrhoid which cuts off the blood supply and results in the haemorrhoid dropping off after typically 10-14 days.

What does hemorrhoid banding treatment involve?

No preparation is required when banding haemorroids. The procedure is non-invasive. A proctoscope or endoscope is inserted into the patient’s bottom. This allows a suction elastic band ligator or a forceps ligator to be used to facilitate the application the of a tight elastic band around the haemorrhoid.

The procedure itself takes a few minutes depending on the number of haemorrhoids, though it is generally accepted that no more than two at a time should be treated in order to minimise discomfort and the risk of bleeding. As an outpatient procedure, the treatment is performed without an anaesthetic.

In some cases, further banding treatments are required.

What are the risks with haemorrhoid banding?

The main issue is mild bleeding. A small amount is perfectly normal, especially after going to the toilet for the first time. If you experience heavy bleeding that does not stop, then you will need to visit the Accident & Emergency (A&E) department of your nearest hospital.

Other after effects include pain, feeling faint, slippage of bands, priapism (erection of the penis not from stimulation but from altered blood flow to it), difficulty in urination, anal fissure and chronic ulceration, all considered as mild complications.

More severe but uncommon complications include severe bleeding, severe pain, urinary retention needing catheterisation, pelvic sepsis and death. Secondary bleeding normally occurs 10-14 days after hemorrhoid banding, with those patients taking anti-platelet and /or anticoagulant treatments more at risk. Early reporting of complications is paramount to allow for early treatment and a favourable outcome.

After haemorrhoid banding treatment

Patients are normally advised to sit quietly to recover after the procedure for a period of 10-15 minutes before leaving the clinic or hospital, just in case patients feel a bit faint afterwards. Typically, patients will experience a dull ache around their anus for 4 to 5 days. Ulcers can occur around the site of the hemorrhoid banding though these usually heal without further treatment.

For any haemorrhoid questions or to organise an appointment with an eXroid consultant, please call us on 0800 999 3777 or click here for all other queries.

Sources:

• Albuquerque A. Rubber band ligation of hemorrhoids: A guide for complications. World J Gastrointest Surg 2016 Sep27; 8(9): 614-620

• Brown SR, Tiernan JP, Watson AJM, Biggs K, Shepherd N, Wailoo AJ, Bradburn M, Alshreef A, Hind D, and the HnbBLe Study Team. Lancet 2016 Jul 23; 388(10042): 356-364

• McCloud JM, Jameson JS, Scott AN. Life-threatening sepsis following treatment for haemorrhoids: a systematic review. Colorectal Dis 2006 Nov; 8(9): 748-755

Sclerotherapy

What is sclerotherapy?

In simple terms, sclerotherapy is the injection of a chemical solution into the area around the haemorrhoid resulting in a scarring reaction which makes the haemorrhoid gradually shrink or shrivel up over time. It is typically reserved for grades 1 and 2 internal haemorrhoids.

During haemorrhoid injections, a chemical solution called a sclerosant, is injected into the submucosa of the back passage (the area of tissue just under the inner lining of the bowel) rather than directly into the blood vessels .

Injections are placed above the dentate line (this is the line or point where the outside sensitive skin becomes the inside less sensitive mucosa, and injecting above this point results in the injections being largely painless).

What does the treatment involve?

The procedure is undertaken by a doctor as an outpatient appointment. No preparation is required, and anaesthesia is not used.

After a proctoscope or endoscope (the tube-like devices a doctor might use to gain access to the inside of the bottom via the anus or bottom opening) is inserted, the doctor will be able to see and access the haemorrhoids. One of these devices is inserted into the anus to open up the anal canal to be able to see the haemorrhoids to be treated. A chemical solution is injected using a needle and syringe around the submucosal area where the haemorrhoid is located. The chemical traditionally used is phenol suspended in almond oil, although sometimes now suspended in groundnut oil. An alternative is 50% dextrose water. The sclerotherapy process gradually hardens (scleroses) the tissue around the hemorrhoid with the development of scar tissue, also called sclerosis. After 4-6 weeks the haemorrhoid should shrivel up. The name sclerotherapy derives from the sclerosing/scarring effect of the treatment or therapy; sclerotherapy literally means scarring treatment.

The treatment typically takes 5-10 minutes and 2-3 haemorrhoids can be treated at one time. Repeat treatments can be undertaken if necessary.

You will normally be asked to avoid any strenuous activity for the rest of the day following treatment. You will usually be able to resume normal activities the next day.

For any haemorrhoid questions or to organise an appointment with an eXroid consultant, please call us on 0800 999 3777 or click here for all other queries.

What are the risks with sclerotherapy injection treatment?

You may experience low level pain for a while but nothing that can’t be managed with over the counter painkillers. You also may have a little bleeding, but this is perfectly normal. Care must be taken in men as injecting towards the front of the body could affect the prostate gland. This could lead to symptoms, including prostatitis (inflammation of the prostate gland), haematospermia (blood in the semen), haematuria (blood in the urine), epididymitis (inflammation of the epididymis or sperm tube) and impotence (the inability to get an erection), although the latter is uncommon.

Side effects are unusual, but the commonest following treatment, apart from mild pain, are ulcers affecting the anal mucosa, which typically heal without any specific treatment. More serious but rare complications include severe allergy to the nut oil the phenol is suspended in, rectal perforation (going through the bowel wall), rectourethral fistula (a connection between the rectum or bottom and the outflow tract of the bladder or urethra), hepatic abscesses (abscesses in the liver), life-threatening sepsis and abdominal compartment syndrome.

One study has shown that a high fibre diet works just as well as sclerotherapy, but without complications.

In another study, immediately after sclerotherapy injection treatment had been performed, a haemorrhoidectomy was carried out and the hemorrhoids removed were examined under the microscope. There were no significant short-term changes seen in the treated tissue where the sclerosant had been injected.

Sources:

• Madoff RD, Fleshman JW. Clinical Practice Committee and American Gastroenterological Association: American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology 2004; 126: 1463-1473.

• Bullock N. Impotence after sclerotherapy of haemorrhoids: case reports. BMJ 1997; 314: 419.

• Senapati A, Nicholls RJ. A randomised trial to compare the results of injection sclerotherapy with a bulk laxative alone in the treatment of bleeding haemorrhoids. Int J Colorectal Dis 1988; 3: 14-126.

• Ganz RA. The evaluation and Treatment of Hemorrhoids. A guide for the Gastroenterologist. Clin Gastroenterol Hepatol 2013; 11 (6): 593-603.

• McCloud JM, Jameson JS, Scott AN. Life-threatening sepsis following treatment for haemorrhoids: a systematic review. Colorectal Dis 2006 Nov; 8(9): 748-755.

Other non-Surgical treatments

There are less common non-surgical treatments available, including injection sclerotherapy, various forms of heat generating treatment including: infrared coagulation (IRC), radiofrequency (Rafaelo), AC electrotherapy (HET) and laser therapy. Cryotherapy is another rarely used treatment (a freezing treatment).

Symptom management: How to manage during and between flare-ups