Haemorrhoids, also known as piles, are swollen blood vessels in the lower part of the rectum or around the anus. While they can cause significant discomfort, bleeding, and pain, a wide range of treatment options exist to help manage symptoms and improve quality of life. The approach to treating haemorrhoids depends on their type, severity, and how they affect each person individually.

Understanding Your Treatment Path: What to Expect When Managing Haemorrhoids

When you’re diagnosed with haemorrhoids, the primary goal of treatment is to reduce symptoms such as pain, itching, and bleeding, and to prevent complications. Treatment choices vary widely depending on whether the haemorrhoids are internal or external, how severe they are, and whether they cause significant problems in your daily life. For many people, simple lifestyle adjustments and over-the-counter remedies provide sufficient relief. However, when these measures don’t work, more advanced options are available.^[1][2]

Haemorrhoids affect a large number of people, particularly those over the age of 50, with nearly half of adults experiencing symptoms by that age. Because they are so common, medical professionals have developed a range of treatments that are continually refined based on clinical evidence and patient outcomes. Some treatments are approved by medical societies and widely used in everyday practice, while others are being investigated in research settings to explore new ways to manage or eliminate haemorrhoids more effectively.^[3][7]

The choice of treatment also takes into account patient preferences, other health conditions, and how haemorrhoids impact your ability to work, exercise, or simply go about your day comfortably. Understanding the options available helps you and your healthcare provider make informed decisions about the best approach for your situation.

Standard Treatment Options for Haemorrhoids

The first line of defence against haemorrhoids is usually a combination of lifestyle changes and home remedies. These strategies are designed to reduce the pressure and irritation that contribute to haemorrhoidal swelling and discomfort. Eating a diet rich in fiber is one of the most important steps. Fiber helps soften stools and increases their bulk, which makes bowel movements easier and reduces the need to strain. Straining is a major factor that worsens haemorrhoids or causes them to develop in the first place.^[8][10]

Foods high in fiber include fruits like bananas, pears, and strawberries, vegetables such as carrots, broccoli, and spinach, and whole grains like oats. If it’s difficult to get enough fiber from food alone, supplements such as psyllium husk (commonly known by the brand name Metamucil) or methylcellulose (Citrucel) can be helpful. It’s important to increase fiber intake gradually to avoid gas and bloating. Drinking plenty of water throughout the day also supports softer stools and easier bowel movements.^[10][14]

Another key recommendation is to avoid sitting on the toilet for extended periods and not to delay going when you feel the urge. Prolonged sitting increases pressure on the veins in the rectal area, and delaying bowel movements can lead to harder stools that require more straining. Some people find it helpful to elevate their feet on a small stool while sitting on the toilet, as this changes the angle of the rectum and can make passing stools easier.^[4][17]

Taking warm baths, particularly sitz baths, can provide relief from pain and itching. A sitz bath involves soaking the anal area in a few inches of warm water for 10 to 15 minutes, two to three times a day. Some people add Epsom salts to the water. This simple practice can reduce swelling and inflammation. After bathing, it’s important to pat the area dry gently rather than rubbing, which can further irritate the skin.^[8][13]

Over-the-counter products are widely available and can offer temporary relief. Creams, ointments, and suppositories containing hydrocortisone help reduce inflammation and swelling. Pads infused with witch hazel or numbing agents can soothe itching and discomfort. These products are generally safe for short-term use, typically up to one week. If symptoms persist beyond this period or if side effects such as dry skin or a rash develop, it’s important to consult a healthcare provider.^[8][10]

Pain relievers such as paracetamol, ibuprofen, or naproxen can help manage discomfort. However, if haemorrhoids are bleeding, ibuprofen should be avoided because it can increase the risk of bleeding. Painkillers containing codeine should also be avoided, as they can cause constipation, which worsens the underlying problem.^[6][14]

For external haemorrhoids that have developed a blood clot (known as thrombosed haemorrhoids), the pain can be sudden and severe. If treated within the first two to three days of symptom onset, excision of the clot can greatly reduce pain and speed up recovery. This minor surgical procedure is usually performed in a doctor’s office under local anaesthesia.^[11][12]

Office-Based Procedures: Non-Surgical Options

When lifestyle changes and over-the-counter treatments don’t provide enough relief, or when haemorrhoids are more advanced, office-based procedures may be recommended. These are minimally invasive treatments that can be performed without the need for general anaesthesia or hospital admission. They are particularly useful for internal haemorrhoids that bleed or cause discomfort.^[10][11]

Rubber band ligation is one of the most commonly used office procedures for treating internal haemorrhoids. During this procedure, a small rubber band is placed around the base of the haemorrhoid, cutting off its blood supply. The haemorrhoid shrivels and falls off, usually within a week. Scar tissue forms in the remaining area, which helps prevent future prolapse. This procedure is quick, typically taking less than a minute, and has a lower failure rate compared to some other methods. It’s particularly effective for grades I to III internal haemorrhoids.^[10][11][13]

Sclerotherapy involves injecting a chemical solution directly into the haemorrhoid tissue. This solution causes the haemorrhoid to scar and shrink by cutting off its blood supply. Like rubber band ligation, sclerotherapy can be performed quickly in an outpatient setting and requires no anaesthesia. The procedure is generally well-tolerated, and many patients experience relief within days.^[10][13]

Infrared coagulation uses infrared light to create heat, which causes scar tissue to form within the haemorrhoid. This scar tissue cuts off the blood supply, leading to shrinkage of the haemorrhoid. The procedure is painless for most patients and can be completed in a matter of minutes. Similarly, electrocoagulation uses an electric current to achieve the same effect. Both methods are suitable for smaller internal haemorrhoids that bleed.^[10][20]

A newer technology called the HET bipolar system is another non-surgical option. This proprietary approach uses energy to denature the blood vessels in the haemorrhoid, causing it to shrink and stop bleeding. The advantage of this method is that it causes minimal damage to surrounding tissue, which can lead to faster recovery and less discomfort.^[13]

Most of these office-based procedures require little to no preparation, and patients can usually return to normal activities soon after treatment. They are particularly appealing to people who want to avoid the risks and recovery time associated with surgery, or who are taking blood-thinning medications that complicate surgical options.

Surgical Treatment for Advanced or Recurrent Haemorrhoids

When haemorrhoids are severe, recurrent, or do not respond to less invasive treatments, surgery may be necessary. Surgical options are typically reserved for grade III or IV haemorrhoids, or for cases where other treatments have failed. While surgery is more invasive and requires a longer recovery period, it often provides more definitive and long-lasting relief.^[8][11]

Haemorrhoidectomy is the surgical removal of haemorrhoids. This procedure can be performed using traditional open or closed techniques. During an open haemorrhoidectomy, the haemorrhoid is removed and the wound is left open to heal naturally. In a closed haemorrhoidectomy, the wound is sutured closed. Both approaches are effective, but the closed method may result in slightly faster healing. Haemorrhoidectomy is highly successful in treating severe haemorrhoids, but it is also associated with more postoperative pain and a longer recovery time compared to office procedures. Patients usually need to be asleep under general or spinal anaesthesia for this surgery, and may need to stay in the hospital for a day or more.^[10][11]

Advances in surgical technology have led to the use of specialized cutting devices such as diathermic or ultrasonic instruments (such as the Ligasure device) during haemorrhoidectomy. These tools can reduce bleeding and may decrease postoperative pain, leading to a more comfortable recovery for some patients.^[11]

Stapled haemorrhoidopexy is an alternative surgical technique. Instead of removing the haemorrhoids, this procedure removes a band of tissue from higher up in the rectum. The remaining haemorrhoid tissue is then pulled back up into its normal position and stapled in place. This reduces blood flow to the haemorrhoids and causes them to shrink. Stapled haemorrhoidopexy may result in less pain and a quicker recovery compared to traditional haemorrhoidectomy. However, studies have shown that symptoms and prolapse are more likely to recur after this procedure, which is an important consideration when choosing a surgical approach.^[11][20]

Haemorrhoidal artery ligation is an emerging surgical technique in which stitches are used to tie off the blood vessels that supply the haemorrhoids, causing them to shrink. This method is particularly useful for grade II or III haemorrhoids. Early results suggest that patients may experience less pain and recover more quickly compared to traditional haemorrhoidectomy, though more research is needed to fully understand its long-term effectiveness.^[11][20]

Surgery carries risks such as bleeding, infection, and pain, and there is also a small chance of complications such as difficulty urinating or, rarely, incontinence. However, for many people with severe or persistent haemorrhoids, the benefits of surgery outweigh these risks. A thorough discussion with a colorectal surgeon can help you understand what to expect and how to prepare for recovery.

Treatment in Clinical Trials: Exploring New Approaches

While current standard treatments for haemorrhoids are effective for most people, researchers continue to explore new therapies that may offer better outcomes, fewer side effects, or quicker recovery times. Clinical trials are research studies that test these new approaches in carefully controlled settings. Information about specific clinical trials for haemorrhoids is limited in the sources provided, but ongoing research typically focuses on refining existing techniques, developing new devices, and testing medications or treatments that target the underlying causes of haemorrhoid formation more effectively.

Clinical trials for haemorrhoids may investigate new minimally invasive devices, improved surgical techniques, or medications that reduce inflammation or prevent recurrence. Trials are usually conducted in phases. Phase I trials focus on safety, testing a new treatment in a small group of people to see if it causes harmful side effects. Phase II trials evaluate how well the treatment works and continue to assess safety in a larger group. Phase III trials compare the new treatment to the current standard to determine if it offers better results or fewer risks. Phase IV trials take place after a treatment has been approved and is in widespread use, monitoring long-term effects and gathering more information about its benefits and risks in real-world settings.^[11]

Participation in clinical trials is voluntary and can provide access to cutting-edge treatments that are not yet widely available. However, not all experimental treatments prove to be better than existing options, and there may be unknown risks. If you are interested in participating in a clinical trial for haemorrhoids, discuss this with your healthcare provider, who can help you find appropriate studies and understand what involvement would entail.

Most Common Treatment Methods

• Lifestyle and Dietary Changes
  • Eating a high-fiber diet with fruits, vegetables, and whole grains to soften stools and reduce straining
  • Drinking plenty of water throughout the day to support easier bowel movements
  • Avoiding prolonged sitting and taking regular breaks to reduce pressure on rectal veins
  • Not delaying bowel movements and avoiding spending too much time on the toilet
  • Regular exercise to combat constipation and manage weight
• Home Remedies
  • Taking warm sitz baths for 10 to 15 minutes, two to three times daily, to reduce pain and itching
  • Using ice packs wrapped in a towel to ease discomfort and swelling
  • Elevating feet with a stool while on the toilet to change rectal angle and ease bowel movements
• Over-the-Counter Treatments
  • Topical creams and ointments containing hydrocortisone to reduce inflammation and swelling
  • Pads with witch hazel or numbing agents to soothe itching and discomfort
  • Fiber supplements such as psyllium husk or methylcellulose to soften stools
  • Pain relievers like paracetamol or ibuprofen to manage discomfort (avoiding ibuprofen if bleeding and codeine-containing painkillers)
• Office-Based Procedures
  • Rubber band ligation: placing a band around the haemorrhoid to cut off blood supply, causing it to fall off
  • Sclerotherapy: injecting a chemical solution to scar and shrink the haemorrhoid
  • Infrared coagulation: using infrared light to create scar tissue and cut blood supply
  • Electrocoagulation: applying an electric current to shrink the haemorrhoid
  • HET bipolar system: using energy to denature blood vessels with minimal collateral damage
• Surgical Treatments
  • Haemorrhoidectomy: surgical removal of haemorrhoids using open or closed techniques, often with diathermic or ultrasonic cutting devices
  • Stapled haemorrhoidopexy: removing a band of tissue and stapling haemorrhoids back into place
  • Haemorrhoidal artery ligation: tying off blood vessels supplying haemorrhoids with stitches
  • Excision of thrombosed external haemorrhoids: removing blood clots from external haemorrhoids within the first few days of symptoms