Office procedures handle most of what walks through the door. Surgery handles the rest, and the honest part of this page is saying which is which rather than selling one of them.
Office-based procedures are used for internal hemorrhoids of grades one to three that have not responded to conservative measures. They are done in a clinic room, take minutes, and need no general anaesthetic. Banding is the most common, and is well regarded for grade two in particular.
The alternatives differ in how they work rather than in how serious they are. Infrared coagulation is applied under direct view through an anoscope. Sclerotherapy suits small internal hemorrhoids, though one review notes that recurrence after it can be higher.
Surgery is not the failure case, it is the correct case for some presentations. Large external disease and prolapse that no longer reduces are the usual reasons, and the comparison page sets out how that line is drawn and what recovery looks like on either side of it, including time off work.
Hamilton procedures
How it is chosen
Matching the Hamilton treatment to the grade
Grading
An anoscope examination establishes which columns are involved and how far they have moved. Everything after this follows from it.
Narrowing the options
Grades one to three that have not settled go to office procedures. Large external disease and fixed prolapse go to surgery.
The procedure
A band, an infrared applicator or an injection, placed through an anoscope, in a clinic room, in a matter of minutes.
Follow-up
A check on what settled, whether another column needs treating, and the habits that decide whether it comes back.
Treatments we use
Every Hamilton hemorrhoid treatment we offer
Each page says what the procedure does, which grade it suits, what the recovery looks like and what it does not fix.
What people ask before a procedure is booked, including the questions that are awkward to ask out loud.
That follows your grade and what you have already tried. Grades one to three that have not responded to conservative care are what office procedures are built for; grade four and large external disease usually are not.
A small band is placed at the base of the hemorrhoid through an anoscope. The tissue loses its blood supply, withers and drops off over the following days. It takes minutes and needs no general anaesthetic.
It is applied under direct view through an anoscope, and works by coagulating the tissue rather than cutting off its supply with a band. Which one suits you depends on the size and position of what is there.
It is not weaker, it is different. It suits small internal hemorrhoids, and one review notes that complication and recurrence rates after it can be higher, so it is chosen deliberately rather than by default.
Large external disease and internal prolapse that no longer reduces are the usual reasons. Surgery is not what happens when office treatment fails; for some presentations it is the correct first choice.
Pregnancy, cirrhosis, Crohn’s disease and immunosuppression, and we expect an endoscopic test within a reasonable interval before banding. If one of those applies, the plan changes rather than simply proceeding.
The examination takes minutes and settles the question this page cannot. Tell us the symptoms and roughly how long they have gone on, and we will take it from there.
