New treatments for piles

Website screenshot: www.ultroid.com

Website screenshot: www.ultroid.com

Published Oct 13, 2015

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London - Many people will suffer at some point from piles - technically, swellings of tissue containing enlarged blood vessels.

But many are too embarrassed to talk about them, let alone seek help.

What’s more, they can be put off by the idea of surgery, which can be painful and involves a hospital stay.

However, there are cutting-edge treatments that are less invasive and potentially less painful. One, Ultroid, where the inflamed blood vessel is zapped with electricity, causing it to shrink, has recently been approved by the National Institute for Health and Care Excellence (NICE).

Although the exact cause of piles (or haemorrhoids) is unclear, increased blood pressure in the veins and excessive straining are thought to contribute.

They can run in families; pregnancy is a risk factor, because the growing baby increases pressure in the abdomen. Piles are also linked to a lack of dietary fibre. Age is another factor.

Haemorrhoid creams, containing anti-inflammatory drugs, steroids or local anaesthetic, may help. Non-surgical treatments include injecting a chemical to cut off the blood supply so the pile shrivels, and “banding”, where an elastic band is put around the pile to starve it of blood.

Surgical options include a haemorrhoidectomy - where the piles are cut off - stapling, which reduces blood supply to the piles, and transanal haemorrhoidal dearterialisation, where stitches are placed in the blood vessels that supply the piles.

Nearly 40 000 procedures for haemorrhoids were carried out in England alone in 2012-2013.

With Ultroid, a small probe is inserted into the rectum, where it delivers a small amount of electricity, six volts, directly to the inflamed blood vessel. This causes a chemical reaction in the blood vessel, disrupting blood flow and causing the pile to shrink. Most people develop two or three piles at a time and treatment takes about ten minutes per pile.

Andrew Jenkins, 45, a quantity surveyor from Margate in Kent, had the treatment two years ago.

He first suffered from piles aged nine, but they worsened in adulthood. “I used over-the-counter creams, but they weren’t hugely effective,” says Andrew. “I’d heard from friends about banding and surgery, but some sounded horrifically painful.”

A few years ago Andrew’s condition began to interfere seriously with his life.”I used to do a lot of manual labour, but the heavy lifting made the problem worse. I couldn’t go to the gym as much because weightlifting could bring it on, causing bleeding. I always had to pack a change of clothes, so it was embarrassing as well as uncomfortable.”

Two years ago, he heard about Ultroid and went to a private clinic in Canterbury. The procedure felt “a bit peculiar”, says Andrew, but wasn’t painful.

“I didn’t need an anaesthetic or sedative. I just lay on my side while they inserted the probe.”

Although he felt “slightly uncomfortable” the following day, he’s had no pain, bleeding or flare-ups since, and says the piles have gone.

Results from treatment in the US - where the device was launched in 2004 - show that about 85 percent of patients suffered no recurrence, a study in the American Journal of Gastroenterology found.

Dr Mark Hudson-Peacock, a consultant dermatologist specialising in skin surgery and laser treatments, who treated Andrew, says: “Sometimes we have to give a second or third treatment to someone with difficult piles, but one treatment normally suffices.”

NICE says Ultroid is safe and effective for piles from grades 1 to 3 - grade 1 piles are characterised by prominent blood vessels; with grade 2, the piles “pop” out, but spontaneously pop back; with grade 3, the pile has to be pushed back.

However, it points out that the treatment may need to be repeated and that there’s little evidence for its use for grade 4 piles, which permanently protrude from the back passage and cannot be pushed back.

 

The procedure isn’t guaranteed pain-free, as Mark Coleman, a consultant colorectal surgeon at Plymouth Hospitals NHS Trust, points out: “About 30 percent of patients do have pain or discomfort with this treatment, which can continue for two weeks.

‘Ultroid is best applied to patients with mild piles. There is not enough evidence to suggest it’s significantly better than the most common therapy, rubber band ligation (banding).”

There is another, far more radical, new treatment for piles, based on the idea that the condition is not a bowel problem, but arises from varicose veins in the pelvis.

Researchers at the University of Surrey - for a study published in the journal Phlebology - analysed scans of more than 400 women and found that a third of those who had piles all had faulty iliac veins, which drain blood from the pelvis and lower limbs.

Blood was flowing back into the bottom of the pelvis and the rectal veins, resulting in a pile.

Mark Whiteley, a consultant vascular surgeon who was part of the research team, has a new procedure targeting the iliac vein - by making a small hole in the neck, and passing a wire through the jugular vein, down to the affected veins.

Foam is injected, followed by a metal coil - these block off the veins, so blood can’t flow back into the pile and it should shrink.

“This doesn’t require an operation, so there is none of the post-operative pain associated with other procedures, quick healing and no embarrassment factor,” the professor explains.

So far Professor Whiteley has treated two patients with Hembolize, as the procedure is known. The first was Tony Hawes, 53, a company director from Chelmsford, Essex, who developed piles five years ago. After creams failed to help, his GP referred him for Ultroid - but the swelling returned, and he started passing blood.

Tony was then referred to Professor Whiteley and underwent the new procedure in March - it normally costs £4 500 (about R81 000), but Tony did not pay for treatment.

He was able to go home the same day, with just a small plaster over the tiny hole in his neck and experiencing only mild discomfort.

Since then, although the piles have not gone yet, the swelling has reduced and he’s experienced just the odd spot of blood.

Justin Davies, consultant colorectal surgeon and clinical director of digestive diseases at Addenbrooke’s Hospital, Cambridge, is not convinced by Hembolize.

“There’s no evidence that this new technique is a successful way of tackling piles,” he says.

“We would need much more research on its safety and success rates to know conclusively whether it’s a better treatment than existing ones.”

 

Daily Mail

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