Are There Alternatives to Surgery For Hemorrhoids?

Medically reviewed by: Gary H. Hoffman, MD

Most people who come to our office for treatment of hemorrhoid symptoms do not need surgery. Initially, we treat all external hemorrhoids and many cases of internal hemorrhoids with at-home methods. This usually includes stool softeners, a diet high in fiber, and topical medications.

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If your symptoms do not respond, or if you already have a more serious case, we will discuss whether an in-office procedure is right for you. These non-invasive or minimally invasive procedures are often a good option for those with first- to third-degree hemorrhoids.

The non-surgical in-office treatments for hemorrhoids include:

Hemorrhoidal Sclerotherapy

Sclerotherapy shrinks inflamed internal hemorrhoids by injecting a chemical solution into the tissue around the hemorrhoid. This is one of the oldest methods of treatment. It is painless. This chemical, known as a sclerosant, is usually phenol. When injected, it causes the tissue to shrink back to its normal size and stops symptoms. It may take several injections for the best results, but this is a safe and effective treatment. Usually, the only side effect of this treatment is minor bleeding. It typically stops quickly after treatment.

Rubber Band Ligation

Rubber band ligation is a procedure that places a rubber band at the base of an inflamed hemorrhoid. This cuts off the blood supply to the tissue, effectively removing it. The hemorrhoid will eventually fall off, usually in a week to two weeks.

To perform this procedure, your doctor will use a specially designed instrument, a ligator. This tube holds ¼-inch rubber bands and applies them over inflamed internal hemorrhoids. Your doctor will likely treat one or two hemorrhoids per visit, so you may need to come back if you have several hemorrhoids. Luckily, the procedure takes only a few minutes and is relatively painless. Most people respond positively to rubber band ligation. Hemorrhoids can come back after this type of treatment, but at-home treatment may be possible.

Some minor pressure is to be expected after this procedure, and may last for up to 48 hours. Usually over the counter pain medicines and sitz baths are enough to offer relief. Very rarely, people experience an increase in pain or serious infection following a ligation. This is rare, however. In most cases, patients can return to work the following day and have no limit on their normal activities. The only major side effect possible is infection. For this reason, it is important to call us right away if you develop a fever or other symptoms of an infection.

Infrared Coagulation

Infrared coagulation is not used as commonly as rubber band ligation or sclerotherapy, but it is a good option for some people. Also known as infrared photocoagulation, this procedure uses a device that projects an intense beam of infrared light to destroy the blood vessels feeding the hemorrhoidal tissue. As in rubber band ligation, the hemorrhoid will fall off within a week or two weeks.

People report some heat and minor pain during the procedure, but it usually fades quickly. Minor bleeding is possible when the hemorrhoid sloughs off, but no other side effects commonly occur.

Which Non-Surgical Treatment Is Right for Me?

The only way to know if any of these procedures are options for you is to make an appointment with a hemorrhoid specialist. We can help you understand the non-surgical treatments for hemorrhoids that are best for you. We will conduct an examination using an anoscope to look at your hemorrhoids and determine the type of treatment you need. Only if your hemorrhoids are particularly bad or if they do not respond to at-home treatments will we consider an office procedure, or surgery.

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