Ratification Date: 28/07/2020
Next Review Date: 28/07/2021
Haemorrhoids – Surgical Management (Piles)
Threshold
If a patient presents with rectal bleeding, they need to be appropriately investigated to determine the cause of the bleeding. If symptoms are suggestive of malignancy, they must be referred under the two week wait pathway
Clinicians to consider the need for surgical management/admission if the patient presents with:
- Extremely painful, acutely thrombosed external haemorrhoids who present within 72 hours of onset OR
- Internal haemorrhoids that have prolapsed and become swollen, incarcerated and thrombosed OR
- Perianal sepsis
Norfolk and Waveney Integrated Care Board (ICB) will fund a referral for non-urgent specialist assessment and management for patients who are experiencing:
- Fourth degree haemorrhoids or third-degree haemorrhoids that are too large for non-operative measures OR
- Perianal haematoma if symptoms are for less than 24 hours duration for clot evaluation OR
- Combined internal and external haemorrhoids with severe symptoms OR
- Thrombosed haemorrhoids when bleeding is problematic, or there is chronic irritation or leakage
OR:
- Patients have tried and did not respond to conservative treatment techniques for a period of 6 months. Treatments include:
- Ensuring stools are soft and easy to pass
- Dietary and lifestyle advice is given
- Symptomatic treatment
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.