What criteria should I use to decide whether to refer a patient with haemorrhoids for surgical intervention?

To determine whether to refer a patient with haemorrhoids for surgical intervention, consider the following criteria:

Urgent Referral/Admission Criteria:

• Extremely painful, acutely thrombosed external haemorrhoids if the patient presents within 72 hours of onset, as reduction or excision may be needed ¹.
• Internal haemorrhoids that have prolapsed and become swollen, incarcerated, and thrombosed, as haemorrhoidectomy may be needed ¹.
• Perianal haematoma if symptoms are less than 24 hours old, for clot evaluation ¹.

Non-Urgent Referral for Assessment and Management (where surgery may be considered):

• Fourth-degree haemorrhoids or third-degree haemorrhoids that are too large for non-operative measures, as haemorrhoidectomy may be needed ¹.
• Combined internal and external haemorrhoids with severe symptoms, as surgery may be required ¹.
• Thrombosed haemorrhoids when bleeding is problematic, or there is chronic irritation or leakage ¹.
• Large skin tags, as surgical excision may be required ¹.
• Patients who do not respond to conservative treatment ¹.
• Patients with recurrent symptoms who do not respond to primary care management ¹.