Will My Hemorrhoids Come Back After PPH or other Treatments?

Medically reviewed by: Gary H. Hoffman, MD

While every patient’s story is somewhat different, nonsurgical treatments and innovative techniques like procedure for prolapse and hemorrhoids (PPH) offer effective treatment for hemorrhoids without the postoperative pain and long recovery of a traditional hemorrhoidectomy. However, you may be more likely to experience a recurrence of your symptoms after one of these less invasive procedures. So are they worth it?

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What Is the General Treatment for Hemorrhoids?

In general, the treatment your doctor recommends for your internal hemorrhoids will depend largely on how they grade your condition after an exam using an anoscope. They will also take into consideration the symptoms you suffer and your health history. If you have a history of symptomatic hemorrhoids, they are more likely to recommend surgical treatment or another option with a lower recurrence rate.

Grade I

Grade I hemorrhoids usually respond well to conservative treatment, including lifestyle changes and topical treatments.

Grade II

Grade II hemorrhoids are often treated with in-office, non-surgical procedures including rubber band ligation. Some Grade III non-symptomatic hemorrhoids may all receive this type of initial treatment.

Grade III

Symptomatic Grade III and some Grace IV hemorrhoids require more invasive treatments such as a surgical hemorrhoidectomy. Other may qualify for PPH.

Grade IV

Severe Grade IV hemorrhoids or those with any tissue that has lost blood flow require immediate medical attention. Often emergency surgery is necessary to free incarcerated tissue or remove any tissue that becomes gangrenous.

Recurrence After a Nonoperative Treatment

Nonoperative hemorrhoid treatments have about a 30 to 50 percent recurrence rate over the first decade. All of these non-invasive procedures are performed in the doctor’s office, and most require only local anesthetic.Of these techniques, rubber band ligation is the most common.

Sometimes used to treat Grade I, II, and III hemorrhoids, rubber band ligation has the lowest recurrence rate of any in-office treatment option. Rubber band ligation is often performed by a surgeon or a colon and rectal specialist. Performed by a well-trained doctor, it is a safe procedure with few risks. However, large internal hemorrhoids may require several rounds of treatment.

If hemorrhoids grow back after treatment, they often respond to conservative treatment such as a diet with increased fiber and over-the-counter topical medications.

Recurrence After a Traditional Hemorrhoidectomy

A traditional hemorrhoidectomy operation is the most effective treatment for hemorrhoids if you consider the possibility of a recurrence over time. When performed by a colon and rectal surgeon, a hemorrhoidectomy offers a recurrence rate around 5 percent. This is true for both open and closed hemorrhoidectomies.

The downside to this procedure, however, is its invasive nature and the post-operative pain. Some people require narcotic painkillers and may miss a week or more of work. It may take several weeks to recover enough to return to your normal activities.

Recurrence After PPH

Because it is a relatively new procedure and is still growing in popularity, there are few long-term results tracking the recurrence rate after undergoing procedure for prolapsing hemorrhoids. When performing this technique, the surgeon does not make an external incision or remove large amounts of tissue like they do in a traditional hemorrhoidectomy. Instead, the surgeons who perform a PPH use a special circular stapler that fits just inside the anus to address the inflamed tissue.

While PPH offers a quicker recovery, considerably less post-operative pain, and a lower rate of complications than traditional excisional surgery, the recurrence rate is likely higher. It is important to note, however, that most recurrences respond to conservative treatment or in-office procedures.

So Is PPH a Good Alternative to an Excisional Hemorrhoidectomy?

Traditional hemorrhoidectomies have been the gold standard of surgical hemorrhoid treatments for decades and remain a good option for the most serious cases or those that are especially complicated. However, newer treatments allow colon and rectal specialists to offer their patients relief without the major post-operative pain or long recovery time. Talk to your doctor about whether an in-office ligation procedure or a stapled PPH might be a good treatment for you based on the facts of your case.

It is important to note, however, that these procedures require technical skill and proficiency. PPH, especially, is a challenging procedure and requires the surgeon to follow a specific protocol to prevent complications. In fact, we use two surgeons to perform each PPH to reduce the risk of a problem. No matter the option you choose for treating your hemorrhoids, you will want an experienced colon and rectal specialist performing your in-office or operative procedure.

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