BLEEDING
Bright red blood on paper, on the stool or in the toilet bowl.
BACK TO SERVICESDISCREET · FUNCTIONAL · INDIVIDUALISED CARE
ANAL, RECTAL & PILONIDAL CONDITIONS
Contemporary options for haemorrhoids, fissure, fistula, pilonidal disease, prolapse and early lesions, prioritising function.
RAFAELO® / LASER / THDSPHINCTER PRESERVATIONTEM / TAMIS
EXPLORE THE PROCEDURESELIXIS · ADVANCED CARE
Same symptom, different disease — accurate diagnosis first
Bleeding, pain or swelling do not always mean haemorrhoids. Examination and selected functional or imaging tests come before treatment.
SYMPTOMS
Symptoms that merit assessment
Haemorrhoids, fissure, abscess or fistula, pilonidal disease and rectal prolapse can cause similar complaints but require different treatment. Proper assessment is particularly important with bleeding or persistent pain.
PAIN
Sharp pain during a bowel movement or continuous throbbing pain.
LUMP OR PROLAPSE
A painful lump or tissue protruding from the anus.
ITCHING
Itching, irritation, moisture or difficulty keeping the area clean.
DISCHARGE
Mucus, pus or foul-smelling discharge may accompany inflammation or a fistula.
FUNCTIONAL CHANGE
Urgency, leakage or incomplete emptying merit functional assessment.
Bleeding should not automatically be attributed to haemorrhoids. Symptoms alone are not diagnostic and examination, endoscopy or imaging may be needed.
PROCEDURES
Each condition and procedure, separately
From tissue-preserving to excisional procedures, selection depends on stage, anatomy and priorities.
01LASER
LASER HAEMORRHOIDOPLASTY
Targeted laser energy within haemorrhoidal tissue to promote shrinkage and fibrosis. Overall superiority to other techniques has not been established.
- WHEN IT MAY BE CONSIDERED
- Selected internal haemorrhoidal disease without a major external component.
- WHAT IT INVOLVES
- Small punctures and controlled intratissue application without wide excision.
02RAFAELO® · RFA
RAFAELO® RADIOFREQUENCY ABLATION
Controlled intratissue thermocoagulation of an internal haemorrhoid with a fine radiofrequency probe, aiming for shrinkage and fibrosis without anoderm excision.
- WHEN IT MAY BE CONSIDERED
- Selected symptomatic internal haemorrhoids, mainly grade II–III, without a dominant large external component.
- WHAT IT INVOLVES
- After local anaesthesia, the probe is placed centrally within the haemorrhoidal tissue above the dentate line and delivers controlled radiofrequency energy. Suitability is confirmed after proctological examination.
03THD · HAL-RAR
DOPPLER-GUIDED THD / HAL–RAR
Localisation and ligation of haemorrhoidal arteries, with mucopexy when prolapse is present. It usually causes less early pain but has higher recurrence than excisional haemorrhoidectomy in advanced disease.
- WHEN IT MAY BE CONSIDERED
- Selected haemorrhoidal disease with bleeding and prolapse of internal haemorrhoidal tissue.
- WHAT IT INVOLVES
- Doppler mapping, ligation sutures and mucosal lifting without anoderm excision.
04MM · ULTRASONIC
MILLIGAN–MORGAN WITH ULTRASONIC ENERGY
Excisional haemorrhoidectomy for advanced mixed disease using modern energy haemostasis.
- WHEN IT MAY BE CONSIDERED
- Large external components, high-grade prolapse or disease unsuitable for a tissue-preserving technique.
- WHAT IT INVOLVES
- Anatomical excision of diseased columns while preserving skin and mucosal bridges.
05FISSURE
ANAL FISSURE TREATMENT
Stepwise treatment of spasm and pain, prioritising continence preservation.
- WHEN IT MAY BE CONSIDERED
- Chronic fissure persisting despite appropriate conservative care.
- WHAT IT INVOLVES
- Topical therapy, Botox or carefully selected lateral sphincterotomy according to risk.
06FISTULA
ANAL FISTULA SURGERY
Mapping of the tract and treatment with the lowest possible sphincter risk.
- WHEN IT MAY BE CONSIDERED
- A persistent tract after an abscess or an active complex fistula.
- WHAT IT INVOLVES
- Drainage or seton, fistulotomy, LIFT or another sphincter-preserving option according to anatomy.
07SiLaC
PILONIDAL SINUS LASER · SiLaC
Intratract laser treatment of selected sinus tracts without wide skin excision. Long-term comparative evidence is limited and does not establish overall superiority.
- WHEN IT MAY BE CONSIDERED
- Selected primary or limited disease without a large acute abscess.
- WHAT IT INVOLVES
- Tract cleaning, fibre insertion and uniform controlled energy during withdrawal.
08RECTOPEXY
LAPAROSCOPIC RECTOPEXY
Anatomical suspension of the rectum for prolapse, tailored to function.
- WHEN IT MAY BE CONSIDERED
- Full-thickness rectal prolapse. For selected internal prolapse, it is considered only after pelvic-floor testing and multidisciplinary review.
- WHAT IT INVOLVES
- Mobilisation or ventral suspension selected according to constipation, continence and anatomy.
09TEM · TAMIS
LOCAL RECTAL EXCISION · TEM / TAMIS
Transanal removal of a selected lesion with magnification and precise margins, without abdominal resection. It does not provide lymph-node staging.
- WHEN IT MAY BE CONSIDERED
- Selected large polyps and, as definitive treatment, only carefully selected low-risk cT1N0 tumours after complete staging.
- WHAT IT INVOLVES
- Full-thickness local excision and closure when appropriate. Adverse final pathology may require subsequent radical resection.
Conceptual anatomical artwork for general information — not a patient photograph or an exact representation of an operation.
PLANNING & SAFETY
Sphincter function is part of the treatment
The newest technique is not automatically the best. The goal is the right balance between disease control, pain, healing and function.
DIAGNOSIS
Accurate examination before treatment.
MAPPING
MRI, ultrasound or functional testing when required.
CONTINENCE
Baseline continence risk is assessed before sphincter surgery.
FOLLOW-UP
Follow-up of healing and functional outcome.
QUESTIONS
FREQUENTLY ASKED QUESTIONS
Short answers before an individualised surgical assessment.
01How long does recovery take?
Recovery varies with the procedure, disease severity and general health. The individual plan covers mobilisation, diet, work and exercise.
02Is laser always better?
No. Overall superiority has not been established. It may reduce access trauma in well-selected cases, but suitability and recurrence risk depend on anatomy and disease stage.
03Is colonoscopy needed for bleeding?
It depends on age, symptoms, family history and warning signs. Bleeding should not automatically be attributed to haemorrhoids.
CLINICAL EVIDENCE
CLINICAL EVIDENCE
The final choice is based on the clinical presentation, individual anatomy and current guidance.
01ASCRS · Management of Hemorrhoids 2024Official guidance for excisional and non-excisional techniquesOFFICIAL SOURCE02European Society of Coloproctology · GuidelinesEuropean colorectal guidanceOFFICIAL SOURCE03ASCRS · HemorrhoidsSymptoms, diagnosis and treatment optionsOFFICIAL SOURCE04ASCRS · Abscess and FistulaWarning signs of abscess and fistulaOFFICIAL SOURCE
This content is educational and does not replace medical assessment. No technique is appropriate for everyone; benefits, risks and alternatives are discussed individually.
INDIVIDUALISED SURGICAL ASSESSMENT
The right operation starts with the right indication.
Symptoms, investigations and alternatives are reviewed during consultation to create a safe, individualised treatment plan.
REA MED practice & directions