Surgery may be recommended if other treatments for haemorrhoids (piles) haven't worked, or if you have haemorrhoids that aren't suitable for non-surgical treatment.
There are many different surgical procedures for piles. The main types of operation are described below.
A haemorrhoidectomy is an operation to remove haemorrhoids. It's usually carried out under general anaesthetic, which means you'll be unconscious during the procedure and won't feel any pain while it's carried out.
A conventional haemorrhoidectomy involves gently opening the anus so the haemorrhoids can be cut out. You'll need to take a week or so off work to recover.
You'll probably experience significant pain after the operation, but you will be given painkillers. You may still have pain a few weeks after the procedure, which can also be controlled with painkillers. Seek medical advice if you have pain that continues for longer.
After having a haemorrhoidectomy, there's around a 1 in 20 chance of the haemorrhoids returning, which is lower than with non-surgical treatments. Adopting or continuing a high-fibre diet after surgery is recommended to reduce this risk.
Haemorrhoidal artery ligation
Haemorrhoidal artery ligation is an operation to reduce the bloodflow to your haemorrhoids.
It's usually carried out under general anaesthetic and involves inserting a small ultrasound probe into your anus. The probe produces high-frequency sound waves that allow the surgeon to locate the vessels supplying blood to the haemorrhoid.
Each blood vessel is stitched closed to block the blood supply to the haemorrhoid, which causes it to shrink over the following days and weeks. The stitches can also be used to reduce haemorrhoids that hang down from the anus (prolapsing).
The National Institute for Health and Care Excellence (NICE) recommends haemorrhoidal artery ligation as a safe and effective alternative to a haemorrhoidectomy or stapled haemorrhoidopexy. It causes less pain and, in terms of results, a high level of satisfaction has been reported.
The recovery time after having haemorrhoidal artery ligation is also quicker compared with other surgical procedures. There's a low risk of bleeding, pain when passing stools, or the haemorrhoid becoming prolapsed after this procedure, but these usually improve within a few weeks.
Stapling, also known as stapled haemorrhoidopexy, is an alternative to a conventional haemorrhoidectomy. It's sometimes used to treat prolapsed haemorrhoids and is carried out under general anaesthetic.
The procedure isn't carried out as often as it used to be because it has a slightly higher risk of serious complications than the alternative treatments available.
During the operation, part of the anorectum – the last section of the large intestine – is stapled. This means the haemorrhoids are less likely to prolapse. It also reduces the supply of blood to the haemorrhoids, which causes them to gradually shrink.
Stapling has a shorter recovery time than a traditional haemorrhoidectomy, and you can probably return to work about a week afterwards. It also tends to be a less painful procedure.
However, after stapling, more people experience another prolapsed haemorrhoid compared with having a haemorrhoidectomy.
There have also been a very small number of serious complications after the stapling procedure, such as fistula to vagina in women, where a small channel develops between the anal canal and the vagina, or rectal perforation, where a hole develops in the rectum.
Other treatment options are available, including freezing and laser treatment. However, the number of NHS or private surgeons who perform these treatments is limited.
General risks of haemorrhoid surgery
Although the risk of serious problems is small, complications can occasionally occur after haemorrhoid surgery.
These can include:
- bleeding or passing blood clots, which may happen a week or so after the operation
- infection, which may lead to a build-up of pus (an abscess) – you may be given a short course of antibiotics after surgery to reduce this risk
- difficulty emptying your bladder (urinary retention)
- the involuntary passing of stools (faecal incontinence)
- a small channel that develops between the anal canal and surface of the skin, near the anus (anal fistula)
- narrowing of the anal canal (stenosis) – this risk is highest if you have treatment on haemorrhoids that have developed in a ring around the lining of the anal canal
These problems can often be treated with medication or more surgery. Ask your surgeon to explain the risks in more detail before deciding to have surgery.
When to seek medical advice
Seek medical advice from the hospital unit where the surgery was carried out or your GP if you experience:
- excessive bleeding
- a high temperature (fever)
- problems urinating
- worsening pain or swelling around your anus
If you're unable to contact the hospital or your GP, call NHS 111 for advice or visit your nearest accident and emergency (A&E) department.