In general, surgery is recommended for cases not responding to other non-surgical treatment methods such as oral medication, local therapy or band ligation.
In cases with advanced grade or severe disturbing symptoms including recurrent bleeding, constant pain or discomfort due to thromobosis, surgery may be advised as a more definitive treatment method.
Just as an aside, rubber band ligation is not suitable for all cases. External piles should not be treated with band ligation due to the rich nerve supply around the anal skin. Doing so can be too painful for anyone to bear. Such cases should consider the surgical approach if treatment is required.
- Dr Quan