Haemorrhoids can be graded as follows:
Rubber band ligation and sclerotherapy
For Grade 1 and Grade 2 haemorrhoids as well as some smaller Grade 3 haemorrhoids you may be suitable to undergo rubber band ligation or sclerotherapy (injection of a liquid to create scarring). This can be performed as a day procedure under either light sedation or a general anaesthetic. Rubber band ligation involves inserting multiple (often 3 or more) small rubber bands just above the top of the haemorrhoids. This cuts off the blood supply to the haemorrhoids and reduces congestion. This is a relatively painless procedure though some may experience some discomfort in the first few days. You may experience some intermittent bleeding in the first couple of weeks after the procedure, however this will usually settle on it's own. On rare occasions the bleeding may be large enough that you require further procedures to treat it. You may also get the urge to open your bowels even when they are empty, this is called tenesmus. This procedure has a success rate of about 70-80% when performed on the appropriate haemorrhoids. Rubber band ligation can often be performed in conjunction with either a colonoscopy or flexible sigmoidoscopy.
Haemorrhoid artery ligation and rectoanal repair (HAL-RAR) or Transanal haemorrhoidal dearterialisation (THD)
This is a relatively new procedure and is typically used for grade 2 and 3 haemorrhoids and is particularly good for circumferential haemorrhoids. It involves the use of a Doppler probe to locate the vessels feeding the haemorrhoids higher up within the anal canal. A suture is then tied around these vessels to cut off the blood supply. A second suture is then placed, called a mucopexy stitch, to lift the haemorrhoid back within the anal canal and prevent prolapse.
The benefit of this procedure is there is no cutting involve which generally equates to less pain. However some small skin tags may be cut out at the same time. In our experience this procedure is not as good when dealing with very large grade 4 haemorrhoids. Recent evidence does suggest that whilst short term results are good, the long term recurrence rate may be as high as 20%. This rate will go up the worse the haemorrhoids to start with. Complications from this procedure are uncommon but include bleeding, infection and urinary retention. As there is no cutting involve the risk of continence problems is rare.
This can be performed as a day case, but more commonly an overnight stay in hospital. This is not a completely painless procedure, with most experiencing some pain particularly with bowel actions over the first few days.
This is the traditional operation for haemorrhoids and has stood the test of time. This involves cutting out the haemorrhoids. It does have the highest success rate in "curing" your haemorrhoids but does come at price, namely pain. Most will experience pain, which is usually with bowel actions and lasting for several hours after for a couple of weeks. This is usually manageable with just tablet pain relief. The wounds will either be left open or partially closed with dissolving sutures. Other potential complications from a haemorrhoidectomy include bleeding, excessive scar tissue creating an anal stenosis, a persistent non-healing wound called a fissure, and damage to the underlying sphincter muscles. These complications however are relatively rare.