HNY Policy and Pathway Repository - East Riding

Haemorrhoids

 

(including Stapled haemorrhoidoplasty, Radiofrequency ablation and Excisional haemorrhoidectomy.)

These interventions are commissioned if:

• grade 1 (rare) or grade 2 haemorrhoids have not improved with conservative measures or non-surgical interventions OR
• there are grade 3 or grade 4 haemorrhoids causing persistent pain or bleeding OR
• there are irreducible and large external haemorrhoids

AND

• a shared decision-making process has been used to support the choice of intervention, taking into account patient’s choice, severity of haemorrhoids and medical comorbidities.

 

Haemorrhoidal artery ligation is not commissioned.

Less severe haemorrhoids can be treated by simple measures including stool softening, anal hygiene, oral and/or topical analgesia.

Non-surgical interventions should be considered next for grade 1 and grade 2 haemorrhoids. These include ligation, injection sclerotherapy, infrared coagulation/photocoagulation, bipolar diathermy and direct-current electrotherapy.

Haemorrhoid surgery can lead to complications. Pain and bleeding are common, and pain may persist for several weeks. Urinary retention can occasionally occur and may require catheter insertion. Infection, iatrogenic fissuring (tear or cut in the anus), stenosis and incontinence (lack of control over bowel motions) are rare complications.

Evidence suggests that Haemorrhoidal artery ligation is less clinically and cost effective than other surgical interventions for haemorrhoids, so it is not commissioned.

EBI Haemorrhoid surgery (AOMRC)

CKS Haemorrhoids (NICE)