Surgical Hemorrhoid Sclerotherapy

Medically reviewed by: Gary H. Hoffman, MD

Anal symptoms are often caused by hemorrhoids, a collection of veins, arteries, nerves and connective tissue in the wall of the anorectum. This normal complex of tissue may enlarge over time, prolapse (fall out of the anus) and cause symptoms.  Internal hemorrhoids occur above the boundary between the rectum and anus. External hemorrhoids are those that form below the anorectal junction. Despite their labels of internal and external, both types may either remain within the anus or protrude outwards.  Symptoms and treatment of hemorrhoids are determined by location of the hemorrhoids and severity of the disease.

Hemorrhoidal symptoms include:

  • Bleeding, especially after bowel movements
  • Itching, skin irritation or burning
  • Rectal discomfort or pain
  • A rectal discharge

Treatment options range from stool softeners combined with topical medications, to office procedures, and finally surgical therapy.  Typically, when hemorrhoid symptoms do not respond to early treatment forms, office procedures are used.   The only way to determine what form of treatment is most beneficial for you is to speak with your doctor. There are several types of outpatient procedure options that your physician may discuss with you.

Hemorrhoidal Sclerotherapy

This procedure involves an injection of a chemical solution called sclerosant into the area directly surrounding the internal hemorrhoids. It is not used to treat external hemorrhoids.  The usual sclerosant is phenol.  It is safe and has been used for many years.  This solution causes scar tissue to form around the hemorrhoid, causing the hemorrhoid to shrink and become asymptomatic.  Hemorrhoidal sclerotherapy is a commonly recommended treatment for symptomatic hemorrhoids.  Side effects may include a short period of minor rectal bleeding.  This stops on its own.  Several injections over a period of time may be needed.

Rubber Band Ligation

Rubber band ligation is another outpatient procedure that involves placing a rubber band around the base of an internal hemorrhoid.  This deprives the hemorrhoid of its blood supply and the hemorrhoid eventually sloughs (falls off). The rubber bands are applied in the office by your physician using an instrument called a ligator.  A hemorrhoidal ligator is a cylindrical shaped tube that has several ¼-inch rubber bands on its end. One or two hemorrhoids can be treated with rubber band ligation during a single visit, and the constricted hemorrhoids are expected to fall off painlessly within in ten days.

Many people respond positively to this form of treatment, and are able to return to their normal routine almost immediately. For most patients only one rubber band treatment per hemorrhoid fixes the problem completely, compared to the often repetitive process of applying ointments.  Severe pain is rare, but may occur if the hemorrhoid was located close to pain sensors within the anal canal.  Rarely, patients may require two or three days of bed rest.  There have been reported cases of severe infection in the area after rubber band treatment and patients are advised to immediately report any severe pain, fever or systemic symptoms to their physician.

Infrared Coagulation

Infrared coagulation, also called infrared photocoagulation, is another treatment that is recommended for small and medium sized hemorrhoids. During this procedure your physician will use a device that provides an intense beam of infrared light to each hemorrhoid.  This application will create enough heat to destroy the blood supply to the hemorrhoid, causing a scar to form in its place.

The treated hemorrhoid is expected to fall off several days after this procedure, resulting in slight bleeding. During this procedure the patient may experience a sensation of heat and mild discomfort. Generally, this does not last after the treatment is concluded.

Infrared coagulation is the least common form of therapy in this group of treatments.

The only way to determine which form of treatment would be of most benefit is to speak with your doctor. Your doctor will be able to diagnose symptomatic hemorrhoids by inspecting the anus and rectum.  It is important to ensure that the pain is not connected to a more serious issue such as a tumor. Your physician may want to perform a more in depth examination using an anoscope or sigmoidoscope to view the lining of your anus or rectum.

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