Skip to main content

Colorectal · UK

The Rafaelo procedure - hour by hour.

A step-by-step walkthrough of the day itself - the proctoscope, the 1 mm probe, the 25 W applications, the peak at 72 hours and the six-week review. Written for patients who prefer the mechanism explained.

Read the hour-by-hour
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What the Rafaelo day costs, end to end.

Prices scale by number of cushions treated and by whether a short GA is preferred over local. The six-week review is bundled - retreatment terms are written into the quote.

In short

Three piles under short GA: £3,200–£4,500, home in 2–3 hours.

Component Indicative range
Rafaelo - single pile (local anaesthetic) £2,500–£3,500
Rafaelo - two piles (short GA) £2,900–£4,000
Rafaelo - three piles (short GA) £3,200–£4,500
Rafaelo with concurrent skin-tag excision £3,000–£4,800
Rafaelo with proctoscopy under GA £2,700–£3,800
Six-week follow-up review Included
Colorectal consultation only £220–£400

The problem

Nobody tells you the peak is at 72 hours, not on the day.

Most Rafaelo pages sell the technique. Very few walk you through the day itself and the four days after - where the actual patient experience lives.

  • The theatre timing

    Applications are seconds each. The proctoscopy and positioning take longer than the radiofrequency. Total time for three cushions is under an hour, most of it set-up.

  • The 72-hour dip

    Day 1 feels deceptively good; day 2–3 is the dull-ache peak. Round-the-clock paracetamol and ibuprofen, not on demand, is the trick.

  • The first bowel motion

    Soft, planned, painless - because a laxative has been on board since the day of the procedure. Straining is the one thing that undoes the work.

The day itself

From arrival to the six-week review - step by step.

The proctoscope, the probe, the wattage, the timing, and what your body does in the seventy-two hours that follow.

  1. 01

    Admission

    Arrive and settle in

    Admissions 60 minutes before your slot. Consent re-checked, allergies and medications reviewed, a small phosphate enema given if you have not self-administered at home.

  2. 02

    Admission

    Meet the anaesthetist

    For local-only, a topical lidocaine gel and perianal block. For a short GA, propofol induction with a laryngeal mask - no intubation, no muscle relaxant.

  3. 03

    In theatre

    Position and proctoscopy

    Left lateral or lithotomy. A disposable proctoscope opens the anal canal; the consultant identifies each haemorrhoidal cushion and grades it in real time.

  4. 04

    In theatre

    The radiofrequency application

    The 1 mm HPR45i probe is placed at the base of each cushion. Approximately 25 W is delivered for 3–6 seconds per application, controlled by an impedance-guided auto-stop.

  5. 05

    In theatre

    Immediate blanching and haemostasis

    The treated mucosa turns pale white as vessels coagulate. Two to three applications per cushion is typical. Total theatre time 15–20 minutes for one pile, 30–45 minutes for three.

  6. 06

    In theatre

    Recovery and discharge

    Sit up at 15 minutes, walk at 30 minutes, home in one hour under local or two to three hours after GA. First bowel motion usually the next morning.

  7. 07

    After

    The 72-hour window

    Day 1–3 the dull ache peaks. From day 4 it fades. Bleeding on wiping settles by week 2. Prolapse continues to improve out to week 6 as coagulated tissue contracts.

Whole day at the hospital: 4–6 hours. Peak discomfort: day 2–3. Bleeding settled: week 2.

When this page helps

Who this walkthrough is written for.

A patient-facing decoding of the procedure that answers the practical questions most consent conversations skip.

  • You want to know exactly what happens

    For patients who prefer the mechanism explained - probe placement, wattage, timing - rather than a glossy overview.

  • You want to plan the day off

    A clear timeline: admissions, theatre, discharge, first bowel motion, first day back at a desk. No vague reassurance.

  • You are choosing between local and GA

    One pile under local is very well tolerated. Two or three piles are more comfortable under a short GA - we set out the trade-offs.

  • You need to know when it will hurt

    The peak is 24–72 hours after treatment, not on the day. We tell you which analgesia to take and when.

  • You have anticoagulation to plan around

    A step-by-step of what to hold, what to continue, and when to restart - checked with your cardiologist or haematologist first.

  • You want an image of the setup

    The proctoscope, the probe, the generator display - described in plain English so nothing on the day is a surprise.

  • You have travelled in for treatment

    A same-day discharge protocol for out-of-town patients - hotel-recovery guidance and a 24-hour phone line included.

  • Red flag before the day

The decisions on the day

Local or GA, one pile or three, add-ons or not.

The small choices that shape your experience - anaesthetic, number of cushions, add-ons like skin-tag excision, and what happens if the surgeon changes plan.

  • Under local anaesthetic

    Perianal lidocaine block. You are awake and comfortable, home in an hour. Best suited to a single cushion - the sensation of the proctoscope is more of a limiter than the radiofrequency itself.

  • Under short general anaesthetic

    A 15–20 minute propofol GA with a laryngeal mask. Preferred for two or three piles, anxious patients, or where a skin-tag excision is being added on.

  • HPR45i probe, 25 W application

    The dedicated 1 mm Rafaelo probe delivers a controlled dose of radiofrequency, monitored by tissue impedance, that stops automatically once the target coagulation is reached.

  • Three cushions in one sitting

    The classic right-anterior, right-posterior and left-lateral cushions can all be treated in a single visit - a reason many patients prefer a short GA over local.

  • Combined with skin-tag excision

    Small perianal skin tags can be excised with fine scissors under the same anaesthetic. Adds 5–10 minutes but avoids a second appointment.

  • Not combined with banding

    Rafaelo replaces banding at the treated cushion - the two do not stack on the same pile. Banding at a neighbouring untreated cushion is fine.

  • Repeat Rafaelo at six weeks

    If a small residual pile emerges on review, a short top-up session - often just one application - is straightforward and cheaper than the first visit.

  • Conversion to formal surgery

    Rare, but honest: if intraoperative findings show grade IV disease or dense fibrosis, the surgeon may recommend a different procedure. Consent covers this in advance.

Recovery, hour by hour

The seventy-two hour window - and the six weeks that follow.

What is normal, what is not, and exactly when to reach for the phone.

  • Hour 0–1: the theatre itself

    You will feel pressure from the proctoscope more than the probe. Under local, a warm sensation at each application lasting seconds. Under GA, you are asleep.

  • Hour 1–24: the deceptive quiet

    The first day is often surprisingly comfortable - local anaesthetic and the effect of the propofol linger. First soft bowel motion usually the next morning with the prescribed laxative.

  • Hour 24–72: the peak

    A dull, deep ache and a sensation of anal fullness is normal. This is when regular paracetamol plus ibuprofen, prescribed round-the-clock rather than as needed, does the heavy lifting.

  • Day 4–14: the fade

    Discomfort drops daily. Minor spotting on paper is expected up to two weeks as the treated mucosa remodels. Straining on the toilet is the one thing to avoid.

  • Week 2–6: the remodel

    The coagulated tissue contracts and fibroses. Prolapse continues to improve. Bleeding should have stopped completely by week three.

  • Anticoagulation held or continued

    Aspirin and prophylactic anticoagulation are usually continued. Clopidogrel, DOACs and warfarin are decided case by case with the prescribing team - never paused on our recommendation alone.

  • Retention and constipation

    Difficulty passing urine in the first 12 hours is unusual but possible - one of the reasons we prefer same-day discharge only after a first void. Constipation is prevented, not treated, with laxatives from day 0.

  • Return to work and exercise

    Desk work day 2–3. Gym and cycling week 2. Heavy lifting and long-haul flights week 3. Nothing in the anal canal (including suppositories not prescribed by the team) for four weeks.

  • Red flags after the procedure

    Fresh heavy bleeding filling the toilet bowl, fever above 38°C, inability to pass urine after 12 hours, or worsening rather than improving pain need the same-day team or A&E, not a routine call.

Reading your operation note

Your Rafaelo note in four parts. Read the last one first.

The discharge note that lands in your inbox keeps to the same shape whichever consultant treats you.

A UK consultant colorectal surgeon reviewing a patient's Rafaelo operation note

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to walk you through the note, the wattage log and the six-week plan, just ask.

  1. 01 Header

    Anaesthetic and set-up

    Local versus GA, position, prophylactic antibiotics if given, and whether the proctoscopy revealed anything unexpected before the probe was deployed.

  2. 02 Technique

    Applications per cushion

    Which cushions were treated, how many applications each received, the wattage and duration, and whether auto-stop or manual stop was used.

  3. 03 Findings

    Immediate tissue response

    Blanching pattern of the treated mucosa, any bleeding requiring adrenaline or a suture, and whether skin tags, a fissure or a fistula were noted for the follow-up plan.

  4. 04 Impression

    Analgesia, laxatives, follow-up

    Read this first: the exact 72-hour analgesia schedule, the laxative regime, when to restart anticoagulation, when to call the team, and your six-week review date.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Rafaelo is usually covered when clinically indicated after failed first-line treatment.

Frequently asked

Everything patients ask about the day itself.

The practical questions consent conversations tend to skip.

  • How long does the Rafaelo procedure take on the day?

    The application itself is quick - 3–6 seconds per application, 2–3 applications per cushion. Add the proctoscopy, positioning and pauses and each cushion takes 5–7 minutes. One pile is 15–20 minutes in theatre; three piles are 30–45 minutes. Admission and recovery either side turn the whole day into about four to six hours from arrival to discharge.

  • What does it actually feel like?

    Under a short GA you feel nothing. Under local anaesthetic the sensation is a firm pressure from the proctoscope and a warm feeling at each radiofrequency application, lasting a few seconds. It is not the sharp pain of injection scars. Most patients describe it as strange rather than sore.

  • When will I have my first bowel motion?

    Usually the morning after the procedure. We prescribe a stool softener from the day of treatment to keep the first motion soft and effortless. Straining is the one thing that can dislodge the coagulated tissue and provoke bleeding, so we plan against it deliberately.

  • When does the pain peak, and what should I take?

    The peak is 24–72 hours after the procedure - later than most patients expect. Regular paracetamol 1 g four times a day plus ibuprofen 400 mg three times a day, taken round-the-clock for the first three days rather than as needed, covers most people. We rarely need to prescribe anything stronger.

  • Can I go back to work the next day?

    Desk work is realistic from day 2–3 for most patients. Heavy manual work, cycling, and gym waits until week 2. Long-haul flights and heavy lifting wait until week 3. We give you a signed note if your employer needs one.

  • What happens at the six-week review?

    A short clinic or video review to check that bleeding has stopped, prolapse has settled and you are back to normal function. If a small residual pile has emerged, a top-up Rafaelo session - often a single application - is straightforward and priced into the original quote.

Related treatments

Looking for something else?