Haemorrhoids – Surgical Management (Piles)

Threshold

Surgical treatment should only be considered for haemorrhoids which are more severe and have not responded to non-operative measure.  Norfolk and Waveney ICB will fund treatment for patients who meet both the following criteria:

• The patient has recurrent grade 3 or grade 4 combined internal/external haemorrhoids with persistent pain or bleeding

 OR 

• The patient has irreducible and large external haemorrhoids

AND 

• Conservative treatments, and outpatient procedures such as banding or injection have been considered and have been tried if clinically appropriate, but the patient’s symptoms have not improved.

Exclusions

This policy does not cover:

• Lesions or symptoms that are suspicious of malignancy, which should be referred via the appropriate pathway
• Patients with significant rectal bleeding, who should be referred for specialist examination

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

On a case to case basis, patients might be eligible for treatment outside of the above criteria, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.