Rafaelo Radiofrequency Ablation

Overview

The Rafaelo procedure uses radiofrequency energy — a precisely controlled form of warmth delivered through a small probe — to gently heat and shrink the haemorrhoidal tissue from the inside. This is called coagulation. Think of it a little like warming a sponge until it contracts and firms up. The probe itself is only a few millimetres wide, and it is positioned above the dentate line — the natural boundary inside the anal canal where there are very few pain-sensing nerve fibres. That is why most people feel very little discomfort during the procedure, and very little pain afterwards.

The Rafaelo is done under sedation — you will be lightly asleep and very relaxed throughout, though not necessarily under a full general anaesthetic. The procedure typically takes around 30 to 45 minutes, and you go home the same day.

Who needs this procedure?

The Rafaelo procedure tends to suit people who want effective treatment with as little disruption as possible. You may be a good candidate if:

• You have Grade II or Grade III internal haemorrhoids causing bleeding or prolapse (tissue that slips out of the anus)
• Minimising pain after the procedure is important to you
• You have already tried rubber band ligation without enough relief, or would prefer a different approach
• You take blood-thinning medication — Rafaelo has a lower risk of bleeding than surgery that cuts tissue away, which can make it a safer option in your situation
• Post-operative pain is a particular concern for you — perhaps because of other health conditions, or simply because you are anxious about the recovery

Benefits

• Very little pain after the procedure — because the treatment targets tissue above the dentate line, where your body has very few pain-sensing nerve endings
• Most people return to their normal daily activities within 24 to 48 hours
• No cuts, no stitches, no open wounds — and therefore a very low risk of infection
• Usually done under sedation rather than a full general anaesthetic, which is gentler on your body and means you recover from the anaesthetic more quickly
• Works well for Grade II and Grade III internal haemorrhoids
• If a single session isn't quite enough, a second treatment session is possible without starting from scratch

Risks & considerations

We want you to feel informed, not worried. Here is an honest picture of what to keep in mind:

• Mild discomfort in the first 24 to 48 hours — a dull ache or feeling of pressure is normal after the procedure. Simple paracetamol handles this well for most people.
• Haemorrhoids can come back over time — studies suggest around 1 in 7 to 1 in 5 patients may need further treatment within 2 to 3 years. The good news is that a repeat Rafaelo session, or a different treatment, can be arranged if needed. Research on long-term outcomes is still growing, and Mr Nguyen will help you understand what this means for you.
• A small amount of bleeding around 7 to 10 days after the procedure — this can occasionally happen as the treated tissue naturally sheds. If you notice more than just a small amount, please contact us straight away.
• Difficulty passing urine (urinary retention) in the day or two after the procedure — this is rare with Rafaelo compared to other haemorrhoid surgeries.
• The first treatment may not achieve everything we hoped for — if that happens, a second session or a different procedure may be recommended. Mr Nguyen will review this with you at your follow-up and you won't be left without a clear plan.
• Rafaelo is a newer technique — compared to haemorrhoidectomy or rubber band ligation, long-term data are still being collected worldwide. Mr Nguyen will help you weigh this honestly against the benefits for your individual situation.

Before the procedure

• You will need a small bowel preparation on the morning of your procedure — Mr Nguyen's team will prescribe a phosphate enema and tell you exactly how and when to use it. It is straightforward and done at home before you leave.
• Stop aspirin and anti-inflammatory pain medicines (NSAIDs such as ibuprofen or naproxen) 5 to 7 days beforehand, if Mr Nguyen's team advises this.
• Because you will be sedated, you will not be able to drive yourself home. Please arrange for a trusted adult to collect you and stay with you for the rest of the day.

On the day

• After you are checked in to the day-stay unit, a nurse will insert a small IV cannula (a tiny tube in the back of your hand) so the sedation can be given. You will quickly feel very relaxed and drowsy — most people have absolutely no memory of the procedure afterwards.
• Mr Nguyen will gently insert a short, hollow viewing tube called a proctoscope to see the haemorrhoids clearly. This is the same type of examination done in the consulting room, but you won't feel it at all because of the sedation.
• The Rafaelo probe is applied to each haemorrhoid in turn. A brief pulse of radiofrequency energy heats and shrinks the tissue. It takes just a few seconds per haemorrhoid.
• If you have multiple haemorrhoids, all of them can usually be treated in the one session — no second visit needed.
• You will then rest comfortably in the recovery area for 1 to 2 hours while the sedation clears.
• Before you go home, the nurses will give you written instructions, a prescription for pain relief, and stool softeners. Please read the instructions carefully when you are home and rested — they cover everything you need to know for the first week.

Recovery & aftercare

• Day of the procedure: Go home, rest, and take paracetamol if needed. A mild ache or feeling of pressure is normal and usually very manageable.
• Day 1 onwards: Most people feel well enough to go back to their normal daily activities the following day. You do not need to take a week off work.
• For the first week: Avoid heavy lifting, gym sessions, or anything strenuous. Your body is doing real internal healing even if you feel fine on the outside.
• Starting straight away: Eat a high-fibre diet — plenty of vegetables, fruit, wholegrains, and legumes — and drink plenty of water each day. Keeping your stools soft and easy to pass is the single most important thing you can do for your recovery and for long-term prevention.
• If your symptoms don't fully resolve: Please don't worry — this happens sometimes, and a second session or a different approach can be arranged. Mr Nguyen will assess this at your follow-up and discuss the options clearly with you.
• Mr Nguyen routinely arranges a follow-up appointment 2 to 6 weeks after your procedure to review how you are going. This appointment is provided at no charge.

Related patient guides

We have written these guides especially for patients and their families. If you have questions about haemorrhoids, bleeding, or what treatment is right for you, these are a good place to start.