Conservative Management (All Grades as First Line)

High-fibre diet (30g fibre per day from fruits, vegetables, legumes, and whole grains); increased water intake (2.5–3 litres daily); avoidance of straining at stool; regular exercise; sitz baths (soaking in warm water for 10–15 minutes, 2–3 times daily); topical anaesthetic/steroid preparations for symptom relief. Conservative management resolves or controls Grade I–II haemorrhoids in many patients and is the essential foundation of treatment at all grades.

Laser Haemorrhoidoplasty (LHP) — The Modern Preferred Technique

Laser haemorrhoidoplasty uses a radially emitting laser fibre (diode laser 980nm or 1470nm) inserted into the haemorrhoidal pedicle through a small introducer needle — no incisions, no stitches. The laser energy causes shrinkage of the haemorrhoidal tissue through submucosal coagulation while preserving the overlying mucosa intact. Suitable for Grade I–III haemorrhoids. Performed under local or spinal anaesthesia as a day-care procedure.

• Minimal post-operative pain — no open wound; no sutures; topical anaesthetic sufficient for most patients
• Same-day discharge — virtually all patients go home the same day within 2–4 hours
• Return to work — most patients return to normal activities within 1–2 days
• Success rate — 85–95% symptom resolution at 1 year for Grade I–III haemorrhoids

MIPH — Minimally Invasive Procedure for Haemorrhoids (Stapled Haemorrhoidopexy)

MIPH (also known as PPH — Procedure for Prolapse and Haemorrhoids; or stapled haemorrhoidopexy) uses a circular stapling device to excise a donut-shaped ring of rectal mucosa above the haemorrhoidal cushions — lifting and repositioning the prolapsed haemorrhoids back into the anal canal, while simultaneously interrupting their blood supply causing them to shrink. Performed under spinal or general anaesthesia; same-day or overnight discharge.

• Suitable for Grade III and selected Grade IV circumferential haemorrhoids
• No perianal wounds — the staple line is above the dentate line (non-sensitive zone)
• Significantly less post-operative pain than conventional haemorrhoidectomy
• Faster return to work (5–7 days vs 2–4 weeks for haemorrhoidectomy)
• Higher recurrence rate compared to haemorrhoidectomy at 5+ years — NICE recommends discussing this before surgery

Conventional Haemorrhoidectomy — Milligan–Morgan (Open) and Ferguson (Closed)

The gold standard for definitive treatment of Grade III–IV haemorrhoids. The haemorrhoidal pedicle is ligated at its base and excised. Milligan–Morgan leaves the wound open to heal by secondary intention; Ferguson technique closes the wound primarily. Haemorrhoidectomy provides the lowest long-term recurrence rate of any technique but is associated with the most post-operative pain (managed with a multimodal analgesia protocol at SurgiPartner partner hospitals). Return to work: 2–4 weeks.

Rubber Band Ligation (RBL)

A small rubber band is placed at the base of the internal haemorrhoid using an anoscope-guided applicator — strangulating the haemorrhoid’s blood supply; it falls off within 7–10 days. Effective for Grade I–II haemorrhoids; requires 2–3 sessions for multiple haemorrhoids. Office-based procedure under no anaesthesia; mild discomfort for 24–48 hours. Complication: significant post-banding pain, haemorrhage (rare), and pelvic sepsis (rare but serious).