While hemorrhoids are common, most only cause minor symptoms and heal without invasive treatment. Once you have an accurate diagnosis, a few weeks of a high-fiber diet and increased water intake often give the swollen veins time to reduce in size and stop causing symptoms. In some cases, your doctor may recommend stool softeners or over-the-counter medications to help ease the pain, itching and irritation during this time.
Hemorrhoids that cause severe symptoms or do not respond to other therapies do sometimes call for surgical removal. However, there are other, less-invasive treatments for both internal and external hemorrhoids that may also be effective.
When is more Treatment Necessary?
In almost every case, conservative treatment is used to attempt to reduce hemorrhoid inflammation before any other treatments are considered. When the hemorrhoids do not respond in two to three weeks, your doctor may begin to discuss other treatment options with you. In rare cases with very large hemorrhoids or heavy bleeding, conservative treatment may be skipped altogether, opting instead for a treatment with faster results.
Even still, most doctors will attempt less invasive treatments than traditional hemorrhoid surgery, such as rubber band ligation or a number of other in-office options. Surgery is still the best option for internal hemorrhoids that protrude through the anus and cannot be pushed back into place, are too large for less invasive treatments, or are bleeding heavily enough to cause complications.
What Types of less Invasive Treatments are Available?
There are several types of in-office treatments that may be used to reduce hemorrhoids after more conservative measures fail to provide quick relief. The most common include rubber band ligation, sclerotherapy and coagulation therapy. After using conservative measures, other treatment modalities should be performed by a colon and rectal surgeon, also known as a proctologist.
Rubber band ligation reduces hemorrhoid swelling and irritation by cutting off the blood flow to the tissue. Small rubber bands are wrapped tightly around the hemorrhoidal base. This procedure is painless, although it can be mildly uncomfortable. Banding procedures may take two or more attempts to completely relieve hemorrhoid swelling, but most people see relief within a few days.
Sclerotherapy also reduces blood flow to the hemorrhoid, stopping bleeding and reducing the inflammation. During this painless procedure, your doctor injects special chemicals into the hemorrhoid. While sclerotherapy is often the best option for people who are taking blood thinners or have a high risk of bleeding during other procedures, it is typically only used on small, internal hemorrhoids. It is less effective on larger, more inflamed hemorrhoids.
There are several methods of coagulation treatments for hemorrhoids, but they all work in similar ways to damage the hemorrhoidal tissue, coagulating the blood flow and forcing the swollen tissue to shrink. Some methods your doctor may employ include infrared light Infrared coagulation, or IRC), cold or heat therapy. These procedures utilize a small scope called an anoscope, that allows the doctor to see internal hemorrhoids and apply the coagulation tools to the proper area. Most patients report mild discomfort from the scope, but no pain from the procedure itself.
Traditional Hemorrhoid Surgery
When conservative or less invasive treatments fail, or when large external or prolapsed internal hemorrhoids require immediate treatment, a hemorrhoidectomy is often the most effective treatment. This hemorrhoid surgery is performed in a hospital or day surgery center, and completely removes the offending tissue.
Depending on your individual needs and your doctor’s preference, hemorrhoid surgery may be done with a number of types of anesthesia. General anesthesia is common, but a spinal block and local anesthesia are also used. A type of twilight anesthesia is often used with the latter methods, ensuring you sleep through the surgery.
Once you are asleep, the colon and rectal surgeon will visualize the hemorrhoids, either using magnifying tools for external hemorrhoids or a scope for internal hemorrhoids. Once there is a clear view of the base of the hemorrhoids, either a scalpel or a cauterizing device is used to create an elliptical-shaped incision and excise the offensive tissue.
After the hemorrhoidal tissue is removed, some doctors opt to sew the site closed with dissolvable surgical suture to help speed healing. Others prefer leaving the site open, reducing the risk of infection.
Once the procedure is complete, you will be moved to a recovery room where you will wake up. In most cases, patients who undergo a hemorrhoidectomy do not require an overnight hospital stay.
Are There Other Surgical Procedures Used for Treating Hemorrhoids?
Prolapsed hemorrhoids may be fixed back into place during an outpatient surgical procedure known as a hemorrhoidopexy, or stapling. Like a traditional hemorrhoidectomy, this procedure requires general or local anesthesia, or a spinal block. The procedure is called PPH, or procedure for prolapse and hemorrhoids.
Once you are asleep, a specially shaped stapling tool is used to secure the prolapsed hemorrhoids back inside the rectum. The staples also reduce blood supply to the tissue, forcing the inflammation to stop. While this procedure is not appropriate for every case, the recovery time is often greatly reduced over traditional hemorrhoid surgery.
Another procedure known as THD or transanal hemorrhoidal dearterialization, is also used to precisely place sutures through the arteries feeding each hemorrhoid, thus depriving each hemorrhoid of oxygen. The hemorrhoid ultimately shrivels.
Your proctologist will be able to discuss the advantages and disadvantages of each type of procedure.
What do I Need to Know about Recovering from Hemorrhoid Treatment?
Depending on the type of treatment you receive, full recovery could take only a few days to several weeks. Over the counter medications and sitz baths can help relieve pain in the meantime. Of course, you will also need to make lifestyle changes to prevent a recurrence of symptoms. This may include eating a high fiber diet, drinking plenty of water, exercising regularly, and taking other actions to ensure you do not become constipated.