Piles ligation/Energy Heat Therapy is commonly done after colonoscopy or sigmoidoscopy examination. The entire procedure generally takes about 30-45 minutes.

For small to medium piles, minimally invasive procedures such as rubber band ligation or coagulation treatment can be used.

1. Rubber band ligation: it is the most widely used procedure. A few tiny rubber bands are placed around the base of the internal piles to cut off its circulation. As the blood supply is restricted, the piles shrink and fall off over several days
2. Coagulation eg. Hemorrhoid Energy Therapy (HET) : low-grade heat energy is applied next to the internal piles to minimize blood flow to the area

These are usually done in the outpatient setting. Most patients report only mild discomfort after the procedures and are able to return to work almost immediately.

You should consider piles ligation or energy heat therapy if

1. Recurrent piles bleeding despite medical therapy
2. Piles swelling
3. Anal pain due to thrombosed piles

Preparing for piles ligation or Heat Energy Therapy is similar to going for colonoscopy. You should fast for at least 6 hours prior to your procedure. You may drink clear fluids up to 2 hours before the procedure.

You will be given medication to clear your bowels to prepare for the procedure. This is known as bowel preparation. It is important to adhere to the instructions for bowel preparation.

In general, most medications can be continued before the colonoscopy with the exception of diabetic medications and blood thinners. Diabetic medications should be omitted during the fasting. You should check with your doctor if your blood thinner needs to be ceased prior to the procedure.

You will be given medication to make you sleepy. Therefore, you must not drive, work or make any important decision after the procedure. A Medical Certificate will be issued, and you should rest at home for the rest of the day.

A nurse will conduct pre-procedure checks, and bring you into the procedure room where an intravenous line will be inserted.

You will be positioned to lie on your left. Sedation will then be administered. After you have fallen asleep, the procedure will begin. It is likely that you will not remember any parts of the procedure. You will be breathing on your own and monitored closely during the procedure. Once the procedure has been completed, you will wake up gradually.

You will be cared for in a recovery area or room. You will be monitored until you have regained consciousness from the anaesthesia. The nurses will provide food and drink after post-procedure assessments. You should arrange for a family member to take discharge instructions and take you home. You should only resume going to work and/or drive the following day. It is common to have mild abdominal discomfort or bloating after a colonoscopy. This usually goes away after 24 hours.

Your doctor will fix an appointment to explain the colonoscopy procedure and findings, including the results of any biopsies taken. He will then discuss the appropriate management plan.

Colonoscopy and piles treatment is a very safe procedure. The most common complications are anal pain and bleeding after piles treatment and ligation which can happens in 10-20% patients. This is expected given the nature of the procedure is to obliterate the blood vessels in the anal cushion. Serious complications are rare and overall occur in 0.1% of colonoscopies. These are often due to disease factors. Such complications include tearing of the colon wall, bleeding and anaesthetic adverse reactions. Unfortunately, emergency surgery or urgent hospitalisation may be required. The risk may be higher in complex cases or those involving interventions. Your doctor will advise you on the complications, precautions, and on what to do should these events occur.

Most patients require up to 2-3 times piles treatment to achieve the best result. You may discuss with your specialist should you have recurrent symptoms.

Piles ligation/treatment is a hospital procedure and is covered under most hospitalisation plans. It is also Medisave deductible. Many companies’ health benefits and private health insurances cover the cost of colonoscopy, which may extend to the private sector. The Ministry of Health provides fee benchmarks and publishes the average fees in each hospital. Before any endoscopic procedure, a detailed financial counselling is done to help patients understand the cost breakdown. Patients should check with their insurance provider and do their own research before seeing a specialist.