Haemorrhoid Treatment Sydney
What are haemorrhoids?
Haemorrhoids, commonly called piles, are swollen veins inside or around the anal passage. These enlarged blood vessels become inflamed and engorged, causing discomfort, bleeding, and irritation. Factors such as constipation, prolonged sitting, pregnancy, or heavy lifting can increase the risk of developing haemorrhoids.
Common Symptoms of Haemorrhoids
If you experience any of the following symptoms, you may have haemorrhoids:
Bleeding
Bright red blood on toilet paper or in the toilet after a bowel motion.
Protrusion
A lump that appears at the anus during or after a bowel motion, which may or may not go back inside on its own.
Discomfort or pain
Larger or clotted haemorrhoids can become very painful, particularly fourth-degree haemorrhoids.
Itching or irritation
Ongoing irritation around the anal passage is common with internal and external haemorrhoids.
Haemorrhoid grades
| Grade | What it looks like | Typical management |
|---|---|---|
| First degree | Bright red bleeding on toilet paper or in the toilet after a bowel motion, with no visible protrusion. | Lifestyle changes, fibre, and topical treatment. |
| Second degree | Bleeds and protrudes from the anus during a bowel motion, then returns inside by itself afterwards. | Rubber band ligation or HAL-RAR. |
| Third degree | Must be manually pushed back inside after a bowel motion; may be painful if large. | HAL-RAR or haemorrhoidectomy. |
| Fourth degree | Permanently protrudes and cannot be pushed back inside; blood inside the haemorrhoid can clot and become very painful. | Haemorrhoidectomy. |
What causes haemorrhoids?
Haemorrhoids are usually caused by chronic constipation (having hard bowel motions that are difficult to pass). Constipation causes you to strain when you go to the toilet. This puts pressure on the blood vessels in the anus, making them swell. Other things can increase the chance you will get haemorrhoids:
- ageing
- being overweight
- having diarrhoea
- spending long periods of time on the toilet
- regularly lifting heavy objects
Haemorrhoids are particularly common during pregnancy. This is because constipation is quite common in pregnancy, but also:
- the growing baby places pressure on the abdomen
- there is more blood flowing through the body
- the hormone progesterone produced during pregnancy enlarges the blood vessels
These haemorrhoids often disappear after pregnancy and might not need treatment. Haemorrhoids may also be more common in some families than in others.
How are haemorrhoids diagnosed?
Diagnosis of haemorrhoids usually involves an examination of the anal passage to look for any swollen blood vessels. Dr Golani may conduct one of the following tests:
- Digital rectal examination, where Dr Golani puts on gloves and places a lubricated finger inside the back passage to gently feel for any abnormalities. This is likely to be uncomfortable but will probably not be painful.
- Proctoscopy, where Dr Golani examines the inside of the rectum using a proctoscope (a hollow tube with a tiny light at the end) to look for any swelling or other symptoms. Again, this may be uncomfortable but will probably not be painful.
How are haemorrhoids treated?
Medicines
Ointments provide symptomatic relief. They don't cure haemorrhoids. Early first-degree haemorrhoids can be treated with lifestyle changes like losing weight, avoiding constipation, and avoiding sitting on the toilet for too long.
Surgery
- Rubber band ligation, where a very tight elastic band is placed around the haemorrhoid to cut off its blood supply. This causes the haemorrhoid to fall off and be passed out of the body within 7 to 10 days.
- Haemorrhoidectomy is the gold standard procedure for treating third degree and fourth degree haemorrhoids. It has the highest success rate in treating haemorrhoids.
- Doppler guided ligation of haemorrhoidal artery is a newer procedure that has the advantage of less postoperative pain compared to haemorrhoidectomy.
Doppler-guided haemorrhoidal artery ligation and recto-anal repair (HAL-RAR)
A new surgical technique to treat haemorrhoids
Doppler-guided haemorrhoidal artery ligation and recto-anal repair (HAL-RAR) is a minimally invasive surgical procedure used to treat haemorrhoids, a common medical condition where the blood vessels in the rectal and anal area become swollen and inflamed. HAL-RAR is a newer technique compared to traditional surgical approaches for haemorrhoid treatment.
How does HAL-RAR work?
- Doppler Ultrasound: The procedure begins with the use of a Doppler ultrasound device. This device helps the surgeon locate and identify the haemorrhoidal arteries that are supplying blood to the swollen haemorrhoidal tissue. The Doppler ultrasound allows for precise localisation of these arteries.
- Haemorrhoidal Artery Ligation (HAL): Once the arteries are identified, the surgeon uses a special instrument to tie off (ligate) these arteries. By blocking the blood flow to the haemorrhoidal tissue, it reduces the swelling and eventually causes the haemorrhoids to shrink.
- Recto-Anal Repair (RAR): In addition to addressing the arteries, Dr Golani may also use sutures or other techniques to repair and reshape the anal or rectal tissue as needed. This helps to correct any structural problems that may be contributing to the development of haemorrhoids.
Advantages of this procedure
There are some key advantages of HAL-RAR over traditional haemorrhoidectomy (surgical removal of haemorrhoids) and other conventional treatment methods. These include:
- Minimally invasive: HAL-RAR is a minimally invasive procedure, which means it involves less cutting and disruption of tissue compared to traditional surgery. This results in reduced post-operative pain and discomfort.
- Outpatient procedure: HAL-RAR is typically performed as a day procedure, which means patients can go home the same day. There is no need for an overnight hospital stay.
- Faster recovery: Patients usually experience a shorter recovery period with HAL-RAR. Many individuals can return to their regular activities, including work, within a few days to a week, depending on the severity of their condition.
- Reduced pain and discomfort: Because HAL-RAR involves ligation of the haemorrhoidal arteries and minimal tissue removal, it is associated with less pain and discomfort compared to traditional surgery. Most patients report less pain during the recovery period.
- Lower risk of complications: The risk of complications such as bleeding, infection, and anal stenosis is generally lower with HAL-RAR compared to traditional haemorrhoidectomy.
- Effective for internal haemorrhoids: HAL-RAR is particularly effective for treating internal haemorrhoids, which are located inside the rectum and are often more challenging to manage with conservative treatments.
- Minimal scarring: Since HAL-RAR involves minimal cutting, it usually results in less scarring compared to traditional surgery, which can be important for cosmetic and functional reasons.
- Customised treatment: The use of Doppler ultrasound allows for precise localisation of the haemorrhoidal arteries, enabling the surgeon to tailor the treatment to the specific anatomy of each patient.
- Potential for symptom relief: HAL-RAR not only addresses the underlying cause of haemorrhoids by ligating the blood vessels but also corrects any structural issues in the recto-anal area that may be contributing to symptoms.
It is important to emphasise that the likelihood of experiencing complications is relatively low, and many people who undergo HAL-RAR have a positive outcome with minimal complications. The procedure is generally considered safer and less risky than traditional haemorrhoidectomy. However, individual experiences can vary, and patients should follow the post-operative instructions carefully to minimise the risk of complications.
Patients considering HAL-RAR should have a thorough discussion with Dr Golani about the potential risks, benefits, and expected outcomes based on their specific condition and medical history. Additionally, they should promptly report any unusual or severe symptoms after the procedure to Dr Golani and their GP for evaluation and appropriate management.
Why See a Colorectal Surgeon for Your Bleeding or Bowel Symptoms?
Rectal bleeding is often caused by haemorrhoids, but other conditions can produce similar symptoms. A colonoscopy is sometimes needed to confirm the diagnosis and rule out more serious causes. Seeing a colorectal surgeon can make a practical difference if your colonoscopy identifies something that requires treatment. When findings such as haemorrhoids, diverticulitis, or polyps need surgical management, having your procedure performed by a surgeon means you can move straight to the next step without delays, extra referrals, or repeating your history to another doctor.
Dr Golani is a colorectal and general surgeon who is also accredited by GESA to perform colonoscopy. This means he can examine you, confirm the cause of your bleeding, and provide treatment directly - including haemorrhoid procedures such as rubber band ligation, HAL-RAR, or haemorrhoidectomy - all under the care of the same doctor, without needing a separate referral.
Frequently Asked Questions
What are the surgical options for haemorrhoids?
The main options depend on the grade of your haemorrhoids and your symptoms. The options include rubber band ligation, poppler-guided HAL-RAR and Haemorrhoidectomy. Dr Golani will examine you, explain which options suit your grade and symptoms, and discuss the benefits and risks of each before you decide. A GP referral is needed to book a consultation.
What is the difference between haemorrhoidectomy and HAL-RAR?
Haemorrhoidectomy is the surgical removal of haemorrhoidal tissue and remains the gold standard for large, third- and fourth-degree haemorrhoids. HAL-RAR uses Doppler ultrasound to locate and tie off the arteries feeding the haemorrhoids without removing tissue, which generally means less pain and a faster return to normal activity, though individual suitability depends on the size and grade of the haemorrhoids.
Is haemorrhoid surgery painful?
Some discomfort is normal after any haemorrhoid procedure, but the level of pain depends on the technique used. Doppler-guided HAL-RAR is designed to reduce postoperative pain compared to traditional haemorrhoidectomy, because it avoids cutting the sensitive anal skin. Dr Golani will discuss pain management options with you before your procedure.
How long does it take to recover from haemorrhoid surgery?
Recovery time varies with the procedure and the severity of the haemorrhoids. Rubber band ligation typically involves very little downtime. Patients who undergo HAL-RAR often return to normal activities, including work, within a few days to a week. Traditional haemorrhoidectomy generally requires a longer recovery period.
Can haemorrhoids come back after surgery?
Any haemorrhoid treatment can be followed by recurrence, particularly if the underlying causes such as chronic constipation or straining are not managed. Maintaining good bowel habits, adequate fibre and fluid intake, and avoiding prolonged straining after your procedure helps reduce the chance of haemorrhoids returning.
When should I see a surgeon about haemorrhoids rather than treating them at home?
You should arrange an assessment if you notice rectal bleeding, a lump that does not go back inside on its own, ongoing pain, or symptoms that do not improve with over-the-counter treatment. Rectal bleeding should always be assessed by a doctor, since it can occasionally be a sign of a more serious underlying condition rather than haemorrhoids alone.
Do I need a GP referral to see Dr Golani for haemorrhoids?
Yes, a GP or specialist referral is required for your consultation and to be eligible for a Medicare rebate. Please bring your referral letter, any relevant scans or test results, and your Medicare and health fund cards to your appointment.
How do I prepare for haemorrhoid surgery?
Dr Golani's team will give you specific instructions ahead of your procedure. In general, you will be asked to fast (avoid food and drink) for a set period before you arrive, and you may be asked to use an enema or a mild laxative beforehand to empty your bowel. If you take blood-thinning medication, let Dr Golani know well in advance, as you may need to pause it for a few days before surgery - always check with Dr Golani before stopping any medicine. Because a general anaesthetic is usually involved, you will need someone to drive you home afterwards.
What can I expect in the first two weeks after a haemorrhoidectomy?
Most people need regular pain relief for the first two weeks, and Dr Golani's team will give you a pain management plan to follow. The perianal area commonly feels rough or tender for around four weeks, which is a normal part of healing, and salt (sitz) baths can help with comfort. Gentle mobilisation and walking are encouraged from the outset to support circulation and recovery. Sedentary work is usually manageable from around a week afterwards, while physically demanding roles generally need two weeks completely off followed by two weeks of light duties, and driving should be avoided for the first five days. A normal diet is fine, with a daily fibre supplement to help prevent constipation, and some bleeding is expected for up to two weeks. Please contact Dr Golani if your pain is worsening rather than settling.
What can I expect in the first few weeks after HAL-RAR (Doppler-guided) surgery?
After Doppler-guided haemorrhoidal artery ligation and recto-anal repair, it's common to notice more frequent bowel motions or an increased urge to go to the toilet in the first few weeks. Some patients experience tenesmus - a sensation of needing to open the bowels even when they're empty, sometimes with straining or cramping - which is temporary and settles gradually. Regular pain relief is often needed for around two weeks, and gentle walking is encouraged throughout recovery. Sedentary work is usually possible from about a week, while physically demanding work generally needs two weeks off followed by two weeks of light duties, and driving should be avoided for the first five days. A daily fibre supplement plus a laxative sachet for the first week helps keep bowel motions soft, and some bleeding is normal for up to two weeks.
When can I return to work, exercise and driving after haemorrhoid surgery?
This varies with the procedure and the demands of your role. As general guidance, walking has no restrictions and is encouraged from the start. Driving should be avoided for the first five days. Sedentary or desk-based work is usually manageable after about a week, while physically demanding work typically needs two weeks completely off followed by two weeks of light duties. Cycling, running and swimming can usually resume from around two weeks post-op. If you're planning air travel, discuss the timing with Dr Golani first. Your own recovery may differ, so follow the specific instructions given by Dr Golani's team for your procedure.
What complications should I watch for after haemorrhoid surgery?
Haemorrhoid surgery is common and generally safe, but as with any procedure there are potential complications to be aware of, including heavier than expected bleeding, difficulty passing urine, infection (which may cause fever), temporary changes in bowel control, or narrowing of the anal canal. Some bleeding and change in bowel habit is expected as part of normal healing, but you should contact Dr Golani or your GP promptly if you notice heavy bleeding, worsening pain, fever, or difficulty urinating.
What happens if I delay or decide not to have haemorrhoid surgery?
If treatment is delayed or not pursued, haemorrhoid symptoms such as bleeding, swelling or irritation may continue, and in some cases can gradually worsen, particularly with larger or more complicated haemorrhoids. Less invasive options can still provide relief for milder symptoms but tend to be less effective for severe haemorrhoids. Waiting does not usually lead to serious health problems, but ongoing bleeding can occasionally contribute to anaemia, and persistent symptoms can make it harder to keep the area clean and comfortable. Dr Golani can help you weigh up whether delaying surgery is reasonable for your situation and discuss other ways to manage symptoms in the meantime.
If I need a colonoscopy to check my bleeding, will the same doctor treat my haemorrhoids?
In most cases, yes. Because Dr Golani is a colorectal surgeon as well as a accredited by GESA endoscopist, he can perform the colonoscopy to confirm the cause of your bleeding and then treat haemorrhoids or other findings directly, without referring you to a separate specialist for surgical treatment.
Which doctor should I see for rectal or anal bleeding, or blood in the stool?
A accredited by GESA colorectal surgeon is the most appropriate specialist to consult. A colorectal surgeon can perform a diagnostic colonoscopy to investigate your symptoms, and importantly, can also provide surgical treatment if your haemorrhoids or other findings require it.
Dr Golani can manage both the diagnosis and the treatment, allowing you to stay under the care of one specialist - usually meaning fewer appointments and less repetition of your medical history.
Is a colorectal surgeon qualified to perform a diagnostic colonoscopy?
Yes. Dr Golani is accredited by the Gastroenterological Society of Australia (GESA) in advanced endoscopic techniques, meeting the same training and competency standards expected of any specialist performing colonoscopy, in addition to his surgical training.
Understanding the Costs of Haemorrhoid Surgery
We understand that the idea of surgery and its associated costs can be overwhelming. To get a better understanding of potential costs, you can review information about hospital and insurance options here. Please note that an initial consultation is necessary to confirm your diagnosis. Once your diagnosis is confirmed, we can provide a more detailed cost estimate for your surgery.
Your Consultation
Dr Golani will provide further discussion regarding the specifics of your diagnosis during your consultation. Additionally, you'll have the opportunity to select the hospital for your procedure and potentially set the date for your procedure.
The best surgical hospitals in Sydney are available for your surgery:
- Sydney Adventist Hospital, Wahroonga
- The Mater Hospital, North Sydney
- Norwest Private Hospital, Bella Vista
- Hornsby Ku-ring-gai Hospital, Hornsby
To schedule a consultation with Dr Golani, please contact our team for a consultation with Dr Golani. We have appointments available at three convenient locations across Sydney:
Please note that a GP referral will be required prior to your consultation.
