Haemorrhoidal artery ligation (HALO)

HALO for Haemorrhoids

Please be aware that the following prices are a guide price. Your final price will be confirmed in writing following your consultation and any necessary diagnostic tests.

Patient pathway	Initial consultation	Diagnostic Investigations	Main treatment	Post discharge care	Guide price
Hospital fees	N/A	Not included	£2,750	Included	£2,750
Consultants fees from	£200	N/A	Included	Included	£200
Guide price	£2,950

Haemorrhoids are structures in the rectum and anus (back passage) that work like cushions to protect the surrounding tissues, help keep the anus closed and allow us to feel when we need to move our bowels. Due to their large blood supply, they commonly become swollen and may be painful, itchy and bleed, a condition known as 'piles'.

Sometimes piles may occur for no obvious reason, but they are more common if you are pregnant, constipated, or have a family history of piles. There are four classifications of haemorrhoids:

Grade I - are visible inside the anus, but do not prolapse (pass outside the anus)

Grade II - prolapse outside the anus when straining or emptying your bowels, but then return to their normal position

Grade III - prolapse outside the anus when straining or emptying your bowels, and need to be manually returned to their normal position

Grade IV - are permanently prolapsed outside the anus

Mild haemorrhoids can often be treated with over-the-counter medications or lifestyle changes, but in severe cases, or if your haemorrhoids are not improving with non-surgical treatments, your consultant may recommend surgery.

There are a number of different treatments for haemorrhoids. Which one is right for you depends on how severe your haemorrhoids are and which treatments you have tried before. Talk to your consultant about which treatment may be best for you.

Non-surgical treatments for haemorrhoids

Non-surgical treatments for piles include

• Rubber band ligation - is a non-surgical procedure where rubber bands are tied around your haemorrhoids cutting off their blood supply and causing them to drop off
• Sclerotherapy - is where a chemical solution is injected into your haemorrhoids to shrink them
• Infrared coagulation - infrared light is used to cut off the blood supply to your haemorrhoids to shrink them
• Electrotherapy - a mild electrical current is applied to the haemorrhoids to shrink them

Surgical treatments for haemorrhoids

Types of surgery to treat piles include:

• Haemorrhoidectomy - your haemorrhoids are removed with surgery
• Stapled haemorrhoidectomy - a surgical procedure where your haemorrhoids are stapled back into the inside of your rectum

At your first consultation, you will usually be seen by a consultant general or colorectal surgeon.

Your consultant will ask you about your symptoms, general health, and any other treatments you have tried including lifestyle changes and over-the-counter treatments.

They will perform a physical examination to assess any external haemorrhoids or insert a gloved finger with lubricant into your rectum to check for any internal haemorrhoids or other abnormalities.

Your consultant may recommend further tests such as a colonoscopy if they suspect you may have another health condition affecting your digestive system.

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it's where your consultant will ask you about your symptoms, perform a physical examination, provide a diagnosis, and discuss possible treatments.

Your initial consultation is also where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have.

At the end of your appointment, your consultant will make a diagnosis based on your symptoms and the physical examination. They will decide whether haemorrhoidal artery ligation is a good option for you and discuss what will happen during the surgery including all the risks and benefits and what to expect during your recovery.

Some benefits of haemorrhoidal artery ligation include:

• It can normally be done as a day case meaning you can go home the same day
• The procedure is minimally invasive and does not require any incisions (cuts)
• Pain is considerably less than with other types of haemorrhoid surgery
• There is a lower risk of complications than with other types of haemorrhoid surgery
• There is less chance of haemorrhoids coming back than with other types of haemorrhoid surgery

Your consultant will tell you everything you need to do to prepare for your surgery. If there's anything you're not sure about, or if you have any questions about how to prepare for your surgery, call the hospital for advice. Being well-prepared for your surgery will ease any anxiety you may have and help your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication, including over-the-counter medicines you are taking.

Your consultant may tell you to stop taking some medications like blood thinners and non-steroidal anti-inflammatory drugs (NSAIDs) before your operation. This is to reduce the risk of bleeding during and after your surgery.

You will not be able to eat or drink anything from midnight on the day of your operation.

It's important that your bowels are prepared before your operation. Either the day before or the morning of your surgery, you will be asked to come to the hospital and given medication or an enema to empty your bowels before your surgery. This makes it easier for your consultant to operate.

What lifestyle changes can I make before my surgery?

Being in the best possible health before your surgery can reduce the risk of complications and speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

Haemorrhoidal artery ligation is normally performed under general anaesthetic which means you’ll be asleep for the procedure. In some cases, you may be given a spinal anaesthetic, which means you’ll be awake during your surgery but won’t feel anything from the waist down. If this is the case, you may also be given some medication to relax you.

Your consultant will discuss which type of anaesthetic is best for you before your operation.

Once your anaesthetic has taken effect, a plastic tube called a proctoscope is placed in the anus to hold your anus and rectum open.

Using a special ultrasound probe, the blood vessels that supply your haemorrhoids are located and the blood supply is cut off using a dissolvable stitch.

The ultrasound probe is removed, and any prolapsed haemorrhoids are stitched back into place inside the rectum.

Haemorrhoidal artery ligation normally takes between 30 minutes and one hour.

Recovery from any type of surgery is different for everyone and depends on factors such as your age, general health and whether there were any complications during your surgery.

Your consultant will give you an estimated recovery timeline based on your individual circumstances.

After your surgery, you will be taken to the recovery room where you will be monitored closely until the effects of the anaesthetic have worn off. You will then be taken to your room.

Will I have pain after my surgery?

You can expect to experience some mild pain or discomfort for a few weeks after your operation. Your consultant will prescribe painkillers to manage this.

Taking a warm bath several times a day can help to ease discomfort. Make sure the water is not too hot and don't add any soap or bubble bath to the water. Make sure you pat the area dry carefully afterwards with a clean towel.

One of the benefits of haemorrhoidal artery ligation is that the procedure doesn't involve any incisions (cuts) and the surgery is done in an area of the rectum with no pain nerves. This means that pain is significantly less than with other procedures. Let your healthcare provider know if you experience significant pain or discomfort after your procedure.

Will I be able to open my bowels after the operation?

As your bowels were emptied before your surgery, you may not feel the need to empty your bowels for the first few days after your operation. Your consultant will prescribe a laxative when you are discharged to help prevent constipation.

It's normal to pass a small amount of mucous from your back passage and to have some light bleeding, especially after a bowel movement for around a week after your procedure. Use a sanitary pad to protect your underwear during this time. Contact your healthcare provider if bleeding is excessive (more than about two teaspoons a day) or continues for more than five days.

You may feel like you need to have a bowel movement but can't after your procedure. This is normal and can last for around two weeks. Avoid straining to move your bowels during this time.

How many nights will I need to stay in hospital?

Haemorrhoidal artery ligation is usually done as a day case, meaning you'll be able to go home later the same day. In some cases, you may need to spend longer in hospital after your operation. Talk to your consultant about how long you can expect to stay in hospital after your surgery.

Will I be able to drive home?

You will not be able to drive yourself home from hospital or for at least forty-eight hours after your surgery due to the general anaesthetic. Please make arrangements for someone to come and collect you, or we can organise a taxi if you prefer.

How soon can I go back to work?

Haemorrhoid artery ligation is a minimally-invasive procedure with a quick recovery time. Depending on the type of job you do, you may be able to return to work twenty-four to forty-eight hours after your procedure. If your job is very physical, you may need to take around two weeks off work. You should avoid heavy lifting for at least two weeks after your surgery.

How soon can I drive?

If you had a general anaesthetic, you must not drive for the first forty-eight hours after your surgery. Your reaction times and concentration may still be impaired even if you feel fine.

After this, you can drive when you can safely control your vehicle and perform an emergency stop comfortably and without pain. This is normally after about a week after haemorrhoidal artery ligation.

Do not drive if you feel drowsy or have difficulty concentrating due to painkillers or other medications and check with your insurance company before driving after your surgery.

When will I be back to normal?

Recovery from surgery is a gradual process that is different for everyone. You can speed your recovery and help avoid complications by following your consultant's instructions carefully after your procedure.

Some things you can do during your recovery include:

• Drink plenty of fluids such as water, juice, coffee, tea, or soup. Aim for at least six to eight glasses a day
• Avoid constipation by eating a fibre-rich diet with plenty of fruits, vegetables, and whole grains
• Avoid straining to have a bowel movement
• Take gentle exercise, but avoid strenuous activity or heavy lifting for at least the first two weeks
• Bathe the area in warm water every day and pat dry
• Do not apply any creams or ointments to the area

Most people are able to resume normal activities around two weeks after haemorrhoidal artery ligation.

As with all types of surgery haemorrhoidal artery ligation carries a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have.

Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision, so please ask any questions you may have.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to haemorrhoidal artery ligation include:

• Urinary retention - contact your healthcare provider if you have difficulty passing urine after your procedure
• Infection - signs may include pain, redness, swelling, unpleasant smelling discharge and fever
• Bleeding - contact your healthcare provider if you are losing more than a couple of teaspoons of blood a day, or if you are still bleeding more than five days after your surgery

We answer some of your most commonly asked questions about haemorrhoidal artery ligation.

Does haemorrhoidal artery ligation work?

Haemorrhoidal artery ligation is a safe and effective procedure to treat haemorrhoids. One study of thirty patients who had undergone the procedure found that after two years symptoms had returned to only one patient, 96.6% of patients experienced no complications and 93% of patients were free of all symptoms by six months after surgery.

How long does the pain last after haemorrhoidal artery ligation?

You may experience mild pain and discomfort for around four to six weeks after your surgery. Your consultant will prescribe pain medications to help with this.

Is haemorrhoidal artery ligation suitable for all haemorrhoids?

Haemorrhoidal artery ligation is normally recommended for grade IV haemorrhoids. These are the most severe type of haemorrhoids where they are constantly prolapsed (hanging outside the body). If you would like to know if haemorrhoidal artery ligation is a suitable treatment for you, make an appointment to discuss this with one of our expert consultants.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about haemorrhoidal artery ligation, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in February 2023. Next review due February 2026.

1. Haemorrhoidal artery ligation, NICE
2. Haemorrhoids: haemorrhoidal artery ligation, PubMed
3. Piles (haemorrhoids), NHS
4. HAL-RAR (Doppler-guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after two-years follow-up, Science Direct