Haemorrhoid banding vs haemorrhoidectomy

Piles are cushions of tissue and blood vessels in the anal canal that can swell, bleed and prolapse. Most are managed with diet, fibre, fluids, avoiding straining and creams. When these are not enough, there is a ladder of procedures, with banding at a lower rung and haemorrhoidectomy at the top.

The sensible principle is to use the least invasive treatment that is likely to work, accepting that some people will need a stronger one.

Through a small tube, the clinician places a tight rubber band at the base of an internal haemorrhoid. The tissue loses its blood supply and shrivels over a week or so, leaving a small scar that fixes the area in place. It takes minutes, usually without sedation, and most people return to normal activity the same day.

Typical effects are a feeling of fullness, an ache and a small amount of bleeding. Rare but serious complications include severe pain, infection or heavy bleeding when the band falls off, which need medical attention. More than one session may be needed, spaced weeks apart.

The surgeon cuts out the haemorrhoidal tissue, usually under general or spinal anaesthetic, and either closes or leaves the wounds. Recovery involves pain for a couple of weeks, stool softeners, painkillers and time off work. Risks include bleeding, urinary retention, narrowing of the anal canal and, rarely, problems with continence.

It is the most effective treatment for large or prolapsed haemorrhoids, and the one with the lowest likelihood of recurrence, which is why it is reserved for those who need it.

Coloproctology guidance advises starting with lifestyle measures, then offering banding for suitable internal haemorrhoids, and considering surgery when haemorrhoids are large, prolapse persistently, or have not responded to other approaches. Alternatives such as haemorrhoidal artery ligation sit between the two options, with lower pain but a higher recurrence rate than haemorrhoidectomy.

Because rectal bleeding can come from other conditions, clinicians examine the bowel when symptoms or age make this appropriate, in line with NICE suspected cancer guidance (NG12), before attributing bleeding to piles.

• Mild bleeding and small haemorrhoids: fibre, fluids and creams first, then banding if symptoms persist.

• Prolapsing haemorrhoids you cannot push back, or very large ones: discuss surgery.

• Repeated banding with early recurrence: ask whether haemorrhoidectomy or an alternative is appropriate.

• Anticoagulant tablets: mention them, since bleeding risk affects the choice and timing.

• Change in bowel habit, weight loss or anaemia with bleeding: see a GP promptly; do not assume it is piles.

Piles are not always the cause of rectal bleeding; other causes need excluding in some people. Banding is not a cure for the cause: constipation and straining can bring them back. And surgery is not a first-line option; it is generally reserved.

It is also a misconception that piles are cancerous or turn into cancer. They do not, but they can coexist with other conditions.