Summary of intervention

This procedure involves surgery for haemorrhoids (piles).


Number of CCG intervention 201718




Often haemorrhoids (especially early stage haemorrhoids) can be treated by simple measures such as eating more fibre or drinking more water. If these treatments are unsuccessful many patients will respond to outpatient treatment in the form of banding or perhaps injection.


Surgical treatment should only be considered for those that do not respond to these non-operative measures or if the haemorrhoids are more severe, specifically:


  • Recurrent grade 3 or grade 4 combined internal/external haemorrhoids with persistent pain or bleeding; or
  • Irreducible and large external haemorrhoids.


In cases where there is significant rectal bleeding the patient should be examined internally by a specialist.


Rationale for recommendation

Surgery should be performed, according to patient choice and only in cases of persistent grade 1 (rare) or 2 haemorrhoids that have not improved with dietary changes, banding or perhaps in certain cases injection, and recurrent grade 3 and 4 haemorrhoids and those with a symptomatic external component.


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) occur more infrequently.