Stages of Haemorrhoids

Haemorrhoids can be classified into stages depending on their severity and symptoms.

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Stage 1
Bleed, particularly at the toilet – the blood may drip or splash into the bowl or colour the toilet paper.

Stage 2
Prolapse – usually with straining of the bowels.  They either return inside spontaneously or need to be pushed back inside.

Stage 3
Thrombose and prolapse – this is very painful and the haemorrhoid cannot be returned inside – not suitable for banding and surgery may be required.

 

Treatment for Haemorrhoids

Depends on their severity (stage or degree) and the main measures consist of:

1. High fibre diet and use of local shrinking and soothing applications such as Rectinol or Cortisone containing creams.

2. Injection sclerotherapy

3. Rubber band ligation

4. For larger, prolapsing, or thrombosed haemorrhoids that cannot be treated with banding, surgery may be recommended. Surgical procedures are usually performed in hospital under anaesthetic and aim to remove or reduce the haemorrhoids. Early assessment and treatment can help prevent symptoms from worsening and may allow treatment with simpler, non-surgical options.

 

Rubber Band Ligation

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Rubber band ligation is a simple and effective non-surgical treatment for haemorrhoids that can be performed in our rooms. Unlike traditional haemorrhoid surgery, the procedure usually does not require anaesthetic or hospital admission, and patients can return home shortly afterwards.

This treatment is most suitable for early to moderate internal haemorrhoids, although not every haemorrhoid can be treated with banding.

Haemorrhoids develop inside the anal canal and contain a rich blood supply, similar to small varicose veins. During the procedure, a small latex rubber band is placed around the base of the haemorrhoid using a specialised instrument called a proctoscope. The band cuts off the blood supply, causing the haemorrhoid to shrink and fall off naturally within a few days.

Because internal haemorrhoids do not contain the same pain-sensitive nerves as the skin around the anus, the procedure is generally well tolerated and only causes mild discomfort for most patients.

Rubber band ligation is not suitable for thrombosed haemorrhoids or haemorrhoids with large external skin tags, as these areas can be painful. In some cases, if the proctoscope cannot be inserted easily due to other conditions, surgical treatment may be recommended instead.

Rubber band ligation offers several advantages, including quick treatment, minimal downtime, and avoiding hospital-based surgery for many patients.

 

Procedure

At the first visit a rectal examination with a glove is performed.  Then the bowel above the haemorrhoids is examined with an instrument called a sigmoidoscope to exclude other causes of bleeding from the bowel.  In patients over 45 a colonoscopy may need to be arranged to ensure no other cause for the bleeding is present.

A suitable time to carry out the rubber band ligation is then arranged.  It is preferable for you to be driven, as occasionally patients can feel faint after the procedure.

Advantages of Rubber Band Ligation

1. no hospitalisation

2. no anaesthetic

3. minimal pain

4. minimal time off work (usually 1 or 2 days)

Possible Disadvantages

1. may require more than one course of treatment.

2. does not deal with external skin tags and loose skin of haemorrhoids.

3. there is a small risk of complications such as aggravation of other haemorrhoids, bleeding, pain or infection.  The pain is difficult to predict and is usually not severe.  There is a bearing down sensation sometimes and Panadeine taken after the procedure is helpful.

After the Procedure

You will be asked to rest in the office to ensure all is okay for 15 minutes or so.  It is best to be driven home.

1. Try not to use your bowels the same day; the rubber band may fall off with the straining.  Occasionally you will note the band.  On most occasions over all you will not even notice the rubber band.

2. Avoid getting constipated or straining.  Two to three teaspoons of bran a day or Coloxyl or Agarol may help.

3. If there is excessive bleeding, lie down with your bottom up in the air.  Gravity usually stops the bleeding.  However, if it persists notify the office.  Anusol or Rectinol ointments may help minor bleeding.

4. A burning or irritating sensation may be present.  Stop all coffee, alcohol and spices and the use of Anusol or Rectinol suppositories.

5. For pain use Panadol, Panadeine, Digesic, Codral Forte or anti- inflammatories such as Nurofen or Nurofen Plus as discussed.

6. If another haemorrhoid becomes inflamed, try to push it back inside and use a suppository.

7. Avoid heavy lifting for up to 2 weeks.

8. For painful external swelling:

• warm baths are helpful

• ice packs help the haemorrhoids shrink

• rest

• try to avoid straining at the toilet

The situation may be reassessed in about eight to twelve weeks to determine how successful the procedure has been. The banding can be repeated if required. An examination is not usually carried out until then, because there is a wound inside where the haemorrhoid has dropped off.  This wound can bleed severely about 10 days after the procedure – rarely.  For this reason it is advisable not to have the banding done if you are going away on holidays or travelling during that time.

If you have other specific medical problems such as being on Warfarin or Aspirin these will need to be considered and probably stopped.  Also if you have a heart valve problem or cardiac murmur an antibiotic cover may be required.