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Haemorrhoids

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It is estimated that between 1:20 and 1:10 of the general population suffer with haemorrhoids, of which 30% seek medical treatment.

What are haemorrhoids?

Haemorrhoids, or piles, are a swelling on the inside of the anal canal which can, in extreme cases, swell and rupture causing bleeding. If left untreated they can become increasingly swollen and painful and may even become infected. Medically they can be classified into four grades:

Grade 1 No prolapse
Grade 2 The haemorrhoids recede by themselves.
Grade 3 The prolapse can be pushed back manually
Grade 4 The haemorrhoids are permanently external

Treatment in the past has involved having them cut out or stapled – procedures which can be painful and may involve protracted recuperation periods.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What are the symptoms associated with haemorrhoids?

Any of the following may be indicative of haemorrhoids:

  • Anal itching

  • Bleeding during bowel movements

  • Sensitive lumps around the anus.

 

What causes haemorrhoids?

The following have been identified as having a possible connection with the development of haemorrhoids:

  • Age

  • Chronic constipation

  • Chronic diarrhoea

  • Straining during bowel movements

  • Overuse of laxatives

 

How can the condition be diagnosed?

Because haemorrhoids are similar to other conditions such as an anal fissure it is important to be seen by a consultant to substantiate diagnosis. This will involve an examination of the anal area.  Rectal bleeding or pain can herald a sinister pathology, such as cancer.

Treatments

Most often haemorrhoids are considered to be mild and changes in lifestyle and diet can be sufficient to alleviate the condition. One aim is to ensure that the stool should be soft and easily passed - a high fibre diet will help achieve this.

Keeping the anal area clean is also important for recovery.  Sitz baths (sitting in warm water) can help bring relief and over the counter wipes containing witch hazel (a natural astringent) can also help.

 

HALO technique

Haemorrhoid artery ligation operation (HALO) is a technique which uses an ultrasound probe within an instrument to access the anal canal (a protoscope) which locate blood flow into the pile.  A stitch down the instrument is used the ligate these vessels which subsequently shrivel.  As this does not involve damaging the skin and is all internal it is a relatively painless, is performed as a day case procedure and recovery is swift.

HALO RAR technique

The HALO procedure works well for smaller haemorrhoids where bleeding is the main problem. When haemorrhoids become larger (grades 3 & 4) both the bleeding and the prolapse need to be addressed.  A relatively recent modification of the HALO procedure called the recto-anal repair (RAR) addresses the prolapse.

A modified hand piece allows a plication stich to pull the prolapsed haemorrhoids back into position inside the anal passage after the HALO has been performed. Approximately 20% of patients can experience pain and spasm post surgery.  This may last a few days, but it is nearly always self limiting and in the vast majority resolves completely.

RAFAELO procedure 

The Rafaelo Procedure is a new treatment that utilises safe and reliable radio frequency technology to reduce, and in most cases, eliminate, the common symptoms of internal (Grade 1-3) haemorrhoids. Similar technology has been used successfully for many years to treat varicose veins in the legs, and this has now been adapted and modified for the treatment of haemorrhoids by the insertion of a special needle probe into the haemorrhoidal cushion, through which radio frequency energy is applied which aims to shrink the haemorrhoids by heating the tissue.

 

What are the benefits of The Rafaelo procedure?

The Rafaelo Procedure is a minimally-invasive, day case procedure, which typically takes no longer than 15-20 minutes to perform. It can be carried out using only local anaesthetic (although some patients may choose to have a mild sedative, or even a general anaesthetic). Most patients report very little pain or discomfort, and as a result the post-operative recovery time is very short.

 

What are the risks of The Rafaelo Procedure?

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. 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.

 

Is The Rafaelo Procedure safe and effective?

The Rafaelo Procedure is a new l treatment, which means that there is not yet much good evidence about how well it works, it’s long-term effects, or how safe it is for treating haemorrhoids. The National Institute for Health and Care Excellence (NICE) has approved the procedure when it is carried out with special arrangements for clinical governance, consent and audit or research (NICE Interventional procedures guidance IPG589).

 

What should I expect after The Rafaelo Procedure?

After the procedure you will be given some painkillers to take home with you. The recovery time from the procedure is normally between one and seven days, depending on the severity of the haemorrhoids. You may be able to return to work immediately or within a couple of days after the procedure. You will be seen again in clinic typically between 6 and 8 weeks after the procedure.

RBL (Rubber band ligation)

A small rubber band is placed around the haemorrhoid. This will starve it of blood and both the band and haemorrhoid will be discharged after a few days and the wound will heal.  This minor procedure can be performed in an outpatient setting for small symptomatic haemorrhoids if appropriate. rubber band ligation.

 

NB

Rectal bleeding and other symptoms of haemorrhoids, can, on occasion, be the presenting symptom of other diseases including cancer and inflammatory bowel disease. 

 

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