Haemorrhoidal artery ligation (HALO)

What is haemorrhoidal artery ligation (HALO)?

Haemorrhoids (piles) are swollen blood vessels inside or around the back passage that can bleed or cause discomfort. Haemorrhoidal artery ligation, often called HALO or HAL, is a procedure that uses stitches to tie off the small arteries that feed the haemorrhoids. With less blood flowing in, the haemorrhoids shrink. Often the haemorrhoid is also stitched back into its normal position at the same time (sometimes called a recto-anal repair).

A small probe with a Doppler (a device that detects blood flow) may be used to find the arteries before they are tied off. The procedure is usually done under general or spinal anaesthetic in theatre, but as it avoids cutting away the haemorrhoid, it is generally less painful afterwards than a traditional operation to remove them (haemorrhoidectomy).

HALO is often used for haemorrhoids that have not settled with simpler treatments such as banding, or that are larger. Compared with banding, trials suggest it is less likely that the haemorrhoids come back within a year, but it usually involves an anaesthetic and a little more recovery.

Like all treatments, it eases the haemorrhoids you have now rather than the straining and constipation that help them form, and they can still come back.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

HALO vs banding vs haemorrhoidectomy

HALO sits between banding and surgery to remove the piles. In the HubBLe trial it had lower one-year recurrence than banding but involved an anaesthetic. Your surgeon will advise what suits your haemorrhoids.

Preparing for your procedure

• See the surgeon, who examines the back passage to confirm the cause and check the haemorrhoids are suitable for this procedure.
• Make sure any unexplained bleeding from the bottom has been properly investigated first.
• Tell the team about all medicines, especially blood thinners, and any allergies.
• Follow the instructions on not eating or drinking before the procedure, as it usually involves an anaesthetic.
• Arrange for someone to take you home and stay with you, as you will have had an anaesthetic.
• Plan around one to two weeks of lighter activity, depending on your job, and keep stools soft with fibre and fluids.
• Stop smoking beforehand if you can, as it helps healing.

What happens

The procedure is usually done under general or spinal anaesthetic, so you do not feel it. A short instrument is placed in the back passage. A small probe with a Doppler may be used to find the arteries supplying the haemorrhoids.

The surgeon places stitches to tie off these arteries, reducing the blood flow to the haemorrhoids. If the haemorrhoids have slipped down, they may also be stitched back up into their normal position (a recto-anal repair). No haemorrhoid tissue is cut away, which is why there is usually less pain afterwards than with a traditional operation.

The procedure often takes around 30–45 minutes. Most people go home the same day once they have recovered from the anaesthetic.

Is this procedure right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

Because no tissue is cut away, HALO is usually less painful than removing the haemorrhoids, but it still involves an anaesthetic and a recovery period. The main concerns are bleeding, short-term difficulty passing urine, and the haemorrhoids coming back over time. Very rarely, a serious pelvic infection can develop, so severe pain, fever or difficulty passing urine after the procedure should be treated as an emergency. The evidence base is smaller than for some older treatments, so ask about your surgeon's experience and results.

Published figures to discuss

Recurrence and complication rates vary by the grade of haemorrhoids, the exact technique and the surgeon's experience, and the evidence base is smaller than for some older treatments. The figures below come mainly from the HubBLe trial and systematic reviews, and should be read as ranges.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

Recovery is usually quicker and less painful than after an operation to remove the haemorrhoids, but more involved than banding because of the anaesthetic. Most people are back to normal over one to two weeks.

• Aching, fullness or an urge to open your bowels for several days
• A small amount of bleeding with bowel movements early on
• Mild discomfort that eases over one to two weeks
• Symptoms improving gradually rather than instantly

Aftercare

• Take painkillers as advised; ask about which to use if you have any bleeding.
• Keep stools soft with plenty of fibre and fluids, and avoid straining on the toilet.
• Avoid heavy lifting and strenuous activity until you feel comfortable.
• Expect a little bleeding with bowel movements early on, but seek advice if it is heavy.
• Restart blood thinners only as advised by the surgical team.
• Know who to contact and what to do if you have heavy bleeding, severe pain, fever or trouble passing urine.
• Keep up good toilet habits and fibre afterwards to reduce the chance of piles returning.

• Someone to take you home and stay with you after the anaesthetic
• Simple painkillers and any prescribed medicines at home
• Fibre and plenty of fluids to keep stools soft
• Around 1–2 weeks of lighter activity planned
• A plan for restarting blood thinners if you take them
• The clinic or out-of-hours contact number saved

Scars and how they heal

No haemorrhoid tissue is cut away and the work is done inside the back passage with stitches, so there is no external scar. Some bleeding with bowel movements is normal in the early days as the area settles. Occasionally a small skin tag or lump remains.

⚠ Get urgent help if…

• Heavy bleeding from the bottom, or passing large clots
• Severe or worsening pain in the bottom or pelvis
• A high temperature, chills or feeling very unwell
• Being unable to pass urine
• Feeling faint, dizzy or breathless
• Pelvic pain with fever and difficulty passing urine — seek urgent help, as a serious infection is rare but important

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result means the haemorrhoids shrink, any prolapse improves, and symptoms such as bleeding and discomfort settle, usually with less pain than after an operation to remove them.

HALO reduces the blood supply to the haemorrhoids present now. It does not stop new ones forming or change the straining and constipation that cause them, and they can come back over time. The evidence base is smaller than for some older treatments, and not everyone has a complete or lasting response, so it is important to have realistic expectations and good follow-up.

HALO can give lasting relief, and trials suggest the haemorrhoids are less likely to come back within a year than after banding. However, recurrence is still possible, and pooled studies report a notable minority of people needing further treatment. Keeping stools soft, avoiding straining and a high-fibre diet help reduce the chance of piles returning.

Related tests, treatments or support

HALO is often considered when simpler treatments such as banding have not worked, and is part of a wider plan that includes self-care measures. If symptoms persist or the haemorrhoids are very large, an operation to remove them (haemorrhoidectomy) may still be discussed.

Follow-up & long-term care

You will usually be reviewed after a few weeks to check your symptoms and healing. If bleeding continues, symptoms persist or new symptoms appear, the cause should be reassessed and further treatment options discussed.

• Keep a high-fibre diet and drink plenty of fluids
• Avoid straining and prolonged sitting on the toilet
• Treat constipation early
• Seek review if symptoms return or new bleeding occurs

Repeat, follow-on and what comes next

• A notable minority of people need further treatment if symptoms persist or return.
• If HALO does not control symptoms, banding or surgery to remove the haemorrhoids may be considered.
• Repeat procedures are sometimes needed, and expectations should be realistic about lasting cure.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• Clear advice on what bleeding and pain are normal and what needs urgent attention, with a named contact.
• Warning signs of serious infection and urinary retention clearly explained.
• Advice on fibre, fluids and avoiding straining to reduce recurrence.
• A plan for restarting blood thinners safely.
• Review arranged to check symptoms and discuss further options if needed.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The surgeon's and anaesthetist's fees
• Theatre time and the facility fee
• The type of anaesthetic used (general or spinal)
• Whether a recto-anal repair is included
• Any examination or test needed to confirm the cause of symptoms
• Follow-up appointments and any further treatment if symptoms persist

• The surgeon's and anaesthetist's fees
• Theatre and facility fees
• The anaesthetic included (general or spinal)
• Any examination or test needed beforehand
• Follow-up appointments
• What happens, and any extra cost, if the haemorrhoids come back or further treatment is needed

On the NHS? Haemorrhoidal artery ligation is available on the NHS in some areas, often when banding has not worked, though availability varies; private care may be used for speed or choice, and unexplained rectal bleeding should be investigated first.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the surgeon is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the surgeon who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• Are my haemorrhoids suitable for HALO, and how does it compare with banding or surgery for me?
• Will the procedure include stitching the haemorrhoids back into place (recto-anal repair)?
• What anaesthetic will I have, and what are its risks for me?
• How experienced are you with this procedure, and what results do you see?
• What should I watch for afterwards, and what counts as bleeding or pain that needs urgent help?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my procedure, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this procedure not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for haemorrhoidal artery ligation (halo)

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NICE — Haemorrhoidal artery ligation (interventional procedures guidance IPG342) HubBLe trial — HAL vs rubber band ligation (The Lancet) HubBLe trial — full report (PMC) NIHR Evidence — newer technique vs rubber band ligation NHS — Piles (haemorrhoids)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.