Haemorrhoids in adults

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This is a summary of the NHS Devon commissioning policy for the referral and specialist management of haemorrhoids in adults

The referral and specialist management of haemorrhoids in adults commissioning policy

Accompanying clinical policy patient support information for the haemorrhoids policy

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Referral Criteria

Referral for specialist assessment and treatment of haemorrhoids is not routinely commissioned in Devon.

Referral will only be funded for:

1. All fourth degree haemorrhoids (haemorrhoids that are prolapsed and incarcerated, and cannot be reduced)

2. Haemorrhoids of any degree when both the following criteria are met

1. The haemorrhoids are recurrent or persistent and associated with persistent bleeding and/or pain (significant discomfort) AND
2. There is failure of documented conservative management techniques* after at least three months.

Conservative management techniques include:

dietary and lifestyle advice (increase fluid and insoluble fibre intake, discourage straining)
bulk forming laxative (or osmotic laxative or stool softener)
non-opioid analgesia and/or topical haemorrhoid preparations for symptomatic relief

Non-surgical treatment

Non-surgical measures (rubber band ligation, injection sclerotherapy or infra-red coagulation) will only be commissioned in the following circumstances:

Recurrent haemorrhoids

AND

Persistent bleeding and / or pain (significant discomfort)

AND

Failure of documented conservative management techniques after at least three months

Surgical treatment

Surgical treatment (haemorrhoidectomy, stapled haemorrhoidopexy or haemorrhoidal artery ligation) will only be commissioned in the following circumstances:

Fourth-degree haemorrhoids

Third-degree haemorrhoids associated with persistent bleeding and/or pain (significant discomfort) that have not responded to non-surgical treatment in line with the above policy statement, or which are too large for non-surgical measures

Second-degree haemorrhoids associated with persistent bleeding and/or pain (significant discomfort) that have not responded to non-surgical treatment in line with the above policy statement.

The removal of anal skin tags is not routinely commissioned in Devon.

Referral Instructions

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be reviewed by the appropriate panel of the CCG upon receipt of a completed application from the patient's GP, consultant or clinician. Applications cannot be considered from patients personally.

Applications for consideration for funding approval should be sent to:

Email: d-icb.ifr-newsdt@nhs.net