Haemorrhoids & Piles Treatment in Johannesburg
Piles — the everyday word for haemorrhoids — are swollen vascular cushions in the anal canal. They are one of the most common reasons adults see a surgeon: bright red bleeding when passing stool, itching, a lump that comes and goes, or discomfort after sitting for long periods. Most piles can be treated without an operation, and even when surgery is needed it is usually a small day-case procedure.
Performed by Dr Pieter Marais at Johannesburg Surgical Hospital, Randburg, Johannesburg.
What it involves
Assessment starts with a careful history and a gentle rooms-based examination, including proctoscopy. Treatment is graded to severity: dietary and stool-softening measures for grade 1, rubber-band ligation or injection sclerotherapy for grade 2 and small grade 3 piles (both done in the consulting rooms with no anaesthetic), and formal surgery — haemorrhoidectomy or stapled haemorrhoidopexy — for large grade 3 and grade 4 piles.
Haemorrhoids are graded 1 to 4. Grade 1 piles bleed but do not prolapse. Grade 2 prolapse when you strain and reduce on their own. Grade 3 prolapse and need to be pushed back manually. Grade 4 are permanently prolapsed and cannot be reduced. Grading matters because it determines what treatment will work.
Rubber-band ligation is the workhorse of piles treatment. A small elastic band is applied to the base of the pile through a proctoscope in the consulting room. The pile shrivels and drops off over the following week. There is no anaesthetic and no time off work. Two to three bands are typically applied a few weeks apart. Success rates for symptomatic grade 1 and 2 piles are above 80%.
For grade 3 and grade 4 piles, or piles that have recurred after banding, formal haemorrhoidectomy is definitive. It is a day-case procedure under general or spinal anaesthesia. The stapled haemorrhoidopexy (PPH) is an alternative for circumferential prolapsing piles — the redundant tissue is lifted and stapled higher up in the anal canal where there are no pain fibres, so recovery is quicker than conventional haemorrhoidectomy.
Bleeding piles are very common, but every patient with new rectal bleeding also needs the rest of the colon checked. Bright red blood on the paper is usually from piles; darker blood mixed with stool, a change in bowel habit, unexplained weight loss, or a family history of bowel cancer are red flags that need a colonoscopy. Dr Marais performs colonoscopy at the same practice — see the gastroscopy and colonoscopy page.
Prevention matters more than most patients realise. Piles are strongly related to constipation, straining and prolonged sitting on the toilet. Fibre, adequate fluid, and getting off the toilet within a couple of minutes will prevent recurrence after any of the treatments above.
When it's indicated
You should be assessed for any rectal bleeding, a lump at the anus, persistent itch, or discomfort passing stool. Rectal bleeding is very often from piles — but colon and rectal cancer can look similar, which is why every patient with new bleeding is offered a colonoscopy or flexible sigmoidoscopy at the same visit to be certain.
The approach
Dr Marais takes the least-invasive route that will actually solve the problem. In-rooms banding cures the majority of piles causing bleeding. Surgery is reserved for large prolapsing piles that banding won't fix, or when banding has been tried and symptoms have returned.
Recovery
In-rooms banding: no anaesthetic, back at your desk within an hour, mild ache and possibly a small amount of bleeding around day 5 to 7 when the pile drops off. Formal haemorrhoidectomy: same-day discharge, one to two weeks off work depending on your job. The first few bowel motions are the most uncomfortable — laxatives, warm salt baths and simple analgesia get you through it. Full healing takes four to six weeks.
Haemorrhoids & Piles Treatment FAQ
- What causes piles?
- Piles are a normal part of anal anatomy that have become enlarged and symptomatic. The main drivers are constipation and straining, prolonged sitting (especially on the toilet with a phone), pregnancy, and a low-fibre diet. Genetics play a role too — some families are simply more prone.
- What are the symptoms of piles?
- The commonest symptoms are bright red bleeding when passing stool (often noticed on the paper), a lump or swelling at the anus that may come and go, itching, mucus discharge, and a dragging discomfort after sitting for long periods. Severe pain is less common and, when it occurs, is usually from a thrombosed (clotted) external pile.
- How is piles treatment done in the rooms?
- Rubber-band ligation is done at the practice with no anaesthetic — a proctoscope is passed, one to three bands are applied to the base of the piles, and you're back on your feet within an hour. Injection sclerotherapy is an alternative in-rooms option for small grade 1 and 2 piles. Neither requires time off work.
- Can piles go away on their own?
- Small piles caused by a short episode of constipation can settle with dietary changes and stool softeners. Piles that keep coming back — with repeated bleeding, prolapse or itching — will not resolve on their own; they need active treatment before they enlarge further.
- Is rectal bleeding always from piles?
- No. Piles are the most common cause, but colon and rectal cancer, inflammatory bowel disease and anal fissures can look similar. That is why any new rectal bleeding should be assessed properly — and, in most patients, followed by a colonoscopy or flexible sigmoidoscopy to check the rest of the colon before assuming piles are the whole story.
- How painful is haemorrhoidectomy?
- The first three to five days after conventional haemorrhoidectomy are uncomfortable — the first few bowel motions in particular. This is managed with laxatives (to keep stool soft), warm salt baths, local anaesthetic gel and simple oral analgesia. Stapled haemorrhoidopexy is significantly less painful and preferred for the right anatomy. Full recovery is four to six weeks.
- Will medical aid cover piles treatment?
- Most South African medical aids cover haemorrhoidectomy and rubber-band ligation for symptomatic piles. In-rooms procedures are typically covered from the day-to-day benefit or specialist consultation benefit depending on the plan. The practice provides a written quote before booking.
- How do I stop piles coming back?
- Fibre, fluid and time off the toilet. Aim for 25–30 grams of fibre a day (fruit, vegetables, wholegrains, or a fibre supplement), 1.5–2 litres of water, and get off the toilet within two to three minutes — reading or scrolling on a phone doubles the strain. Regular exercise and treating chronic cough or constipation early all lower recurrence.
Discuss haemorrhoids & piles treatment with Dr Marais
Send a short enquiry and the practice will be in touch during weekday office hours. Consultations take place at Johannesburg Surgical Hospital.
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