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Blog - Help for Pile Sufferers - Treatment Options

More than 70% of the population will suffer from haemorrhoids/piles at some point in their lives and, for many, it can be very distressing. It can affect your life in so many ways and, in extreme cases, have a serious impact on your mental health. Too often, people suffer in silence, too embarrassed to discuss it with their partner, let alone a Doctor, and so live with their daily symptoms hoping they will go away. When they do eventually pluck the courage to visit their GP, some have been met with ridicule and disappointment, left believing that their issue is unimportant in the context of other ailments and that they are responsible for their condition through poor diet and lifestyle.

Once you have built the courage to overcome the indignity of that first examination, the last thing you want to hear is "eat more fruit and bran" and "try not to sit down all the time". You want it treated, not with a supository or cream to numb the pain, you want it 'treated', you want it 'cured', you want it to 'go away'!.

The treatment of haemorrhoids, otherwise known as piles, is varied in its effectiveness, its reliability, its safety and its invasiveness. What that means is there are indeed many treatment options, but some are more effective than others, some more painful than others and some will last longer than others. Your suitability for different treatment options will depend upon the severity and symptoms of your particular condition. We will explain what those options are, as simply as possible. There are one or two others, which we have omitted, which promise the world but deliver very little. Do your research and, most importantly, take advice from a colorectal surgeon, one who has all treatment options available to them and who can advise on whats best for you. 


Rubber Band Ligation (Banding)

Banding is a process, usually carried out in the Consulting Room as an outpatient procedure, whereby a small rubber band is applied to the pile using a specially designed 'gun', wrapping tightly around it, strangulating it. The pile itself is formed as an inflammed nodule of tissue, fed by a blood vessel and, by applying a tight band around it, the blood supply is cut off, the tissue eventually dies and then falls away. This treatment is reserved generally for minor Grade 1 or Grade 2 haemorrhoids, those without any significant size or prolapse. It can be painful but that pain is often short lived. It can be succesful but studies show a 30%+ recurrence rate meaning that it isn't always expected to be a permanent resolution and they will often return. Some people might be treated with banding and be cured for life, but in the main this might well need to be repeated over time. Most colorectal surgeons in most hospitals, private and NHS, will having banding as a treatment option.


Injections (Sclerotherapy)

Injection sclerotherapy is also used on the lower grade haemorrhoirds and is where the surgeon will inject an oily sclerosant fluid into the affected tissue, causing a chemical reaction with the feeder vessel, ultimately cutting off the blood supply and causing the tissue to shrink, die and fall away. Once again, this does have quite a high failure rate and is being offered less and less in practice. Surgeons will have their preferred treatment options, based on their own experience with it and so you will need to find one who offers it if that is what you want.


Radio Frequency Ablation (Rafaelo)

Rafaelo is the latest option available, using revolutionary radio frequency energy to cut off the blood supply to the haemorrhoid, once again causing it to shrink, die and fall away. It is designed to treat all grades of internal piles and can be carried out under local anaesthetic. A sharp probe is inserted into the pile and the energy applied, causing it to heat up to 100 degrees instantly and in doing so destroys the internal blood vessel. It is relatively painless, both during and post procedure, and you should benefit from instant cessation of symptoms, enabling you to resume your daily activities almost immediately. Recent studies have shown around a 90% success rate, with little chance of serious complication or recurrence, and over 85% of people questioned having had Rafaelo say that they would strongly recommend it. Rafaelo is available across the UK in private hospitals and in a growing number of NHS hospitals too, as surgeons seek to provide a long lasting resolution to symtoms without the pain, risk and failure attributed to other treatment options.


Haemorrhoidal Artery Ligation

This procedure is generally reserved for larger or prolapsing piles, often Grade 3 or 4, where the haemorrhoid cushion becomes very enlarged, causing serious bleeding and/or discomfort. It is only performed under general anaesthetic as it can be a very painful procedure. The haemorrhoidal arteries are generally located using a doppler ultrasound and are then ligated using sticthes to stem the flow of blood. For larger prolapsing piles, a mucosal stitch is also applied to the offending tissue. This procedure can cause significant post operative pain whilst the treatment area recovers, lasting several weeks in some cases, and any treatment carried out under general anaesthetic of course carries its own associated risk. This technique is relatively successful but comes at a cost in terms of pain and risk.



Historically, a full blown haemorrhoidectomy was considered to be the gold standard in haemorrhoid treatment. It should be reserved for only the most serious cases, often with large external elements, although some hospitals still offer it for the majority of cases, despite other, less invasive, treatment options being available. This approach can take the form of simply cutting away the offending tissue with a diathermy leaving an open wound or else using a staple gun to cut and staple the enlarged tissue. In either case, the treatment is always carried out under general anaesthetic due to its very painful nature and the patient should expect several weeks of painful recovery post operatively, necessitating long absences from work. It too has its failure rates. This should be the treatment of last resort and so we recommend you search for surgeons offering all treatment options in case you would be suitable for something less invasive. 

Date posted - 04 January 2023

Author - The Rafaelo Team

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