Best Treatment for Hemorrhoids and Fissures

Haemorrhoidal tissue(cushions) are normal tissue in the anal canal and very lower rectum, that swell at times and then collapse as stool presses on them passing through. The tissue is underneath the lining and made up of some muscle fibres and some blood vessels. When this tissue causes symptoms such as bleeding and sliding out, it is called “haemorrhoids”

Very common. They can cause symptoms in about 5% of the population, but can be present in up to 20% of the population.

No they cannot. Bleeding from the bottom can be from haemorrhoids or sometimes cancer however.

Yes, however if there is bleeding or a lump you must get checked by your doctor.

There are several over the counter ointments and suppositories for haemorrhoids. Most have anti-inflammatory and local anaesthetic components. Proctocedyl, Rectinol, Soovit are some commonly used ointments.

 

Conservative Treatment

Dealing with haemorrhoid bleeding, often a “trial of fibre” is recommended as this can reduce pressure during evacuation and thereby reduce bleeding.

 

Office Treatments

  1. Banding. This is a popular treatment in Australia. Bands can be applied in the office with specially made applicators or sometimes suction machines. The application of a band takes 10 minutes and often 2 bands are applied. The application can cause discomfort which can build up and last a few days. We recommend Panadol and warm baths to reduce discomfort if it occurs.
  2. Injection Sclerotherapy. This is a popular treatment in America. The material used is Phenol. It is easily done in the rooms and causes minimal discomfort.
    Both these treatments are useful for small to medium sized internal haemorrhoids.
    Larger haemorrhoids will not often be controlled by these treatments.

Surgery Treatments

Surgery is usually reserved for large internal haemorrhoids that fail office treatment, and internal-external haemorrhoid combination, or significant external haemorrhoids.

Excisional surgery

a. Thrombosed external haemorrhoid: Excision can often be done in the office under local anaesthesia. If the swelling has been present for some days and it is reducing, it is often left alone to resolve.

b. Open or closed excisional haemorrhoidectomy: This usually involves excision of inter-external haemorrhoids which are often in three locations around the anal canal. The technique favoured in this clinic is the Milligan-Morgan haemorrhoidectomy with excision of the haemorrhoid, suture ligation at the top of the internal haemorrhoid and leaving the wound open to heal over time.

c. Stapled haemorrhoidectomy: This addresses large internal haemorrhoids not responding to office treatment. The stapled-excised area is generally at the upper part of the haemorrhoid in order to reduce postoperative pain.

d. Haemorrhoid artery ligation and rectoanal pexy.[HAL-RAR}. This is a non-excision technique aimed at reducing blood flow to the haemorrhoid and fixating the haemorrhoid column to prevent prolapse.

All operative procedures are done under general anaesthesia. It is recommended that all patients stay overnight in the hospital after surgery.

Results:
Excisional haemorrhoidectomy has best long-term cure rates but the pain and healing period is longest.
Stapling has less post operative pain and higher recurrence rate than excisional surgery by a factor of 5%
HAL-RAR is least painful but has highest failure rate.

This clinic performs all the above treatments. The options will be discussed with you.
A future treatment-Laser haemorrhoid ablation-will be trialled soon.

What to do after surgery.
You will be discharged from hospital the day after surgery. In general it is recommended you stay for your first bowel action after surgery. In some cases a pack is placed after surgery and this must be removed before you leave hospital.

  • The discharge should include medications-2 laxatives, oral analgesia, and sometimes local anaesthetic ointment.
  • An appointment should be made for review in 4 weeks.
  • With open haemorrhoidectomy you may need up to 2 weeks off work. With the other surgeries(HAL-RAR, Stapled haemorrhoidectomy) you will need 1 week or less off work.

Are there any complications?
Potential complications include bleeding, infection, poor result or recurrence.
These will be outlined during consultation.