Nonoperative treatments for internal hemorrhoids
There are several nonoperative treatments for internal hemorrhoids. All of them have the same effect. These procedures cause inflammation in the hemorrhoidal cushions, which then produces scarring. The scarring causes the cushions to shrink and attach to the underlying muscle of the anal canal. This prevents the cushions from being pulled down into the anal canal. These treatments do not require anesthesia since they do not cause pain. (The treated area contains only visceral nerves.)
Sclerotherapy: Sclerotherapy is one of the oldest forms of treatment. During sclerotherapy, a liquid (phenol or quinine urea) is injected into the base of the hemorrhoid. Inflammation sets in, and ultimately scarring takes place. Pain may occur after sclerotherapy but usually subsides by the following day. Symptoms of hemorrhoids frequently return after several years and may require further treatment.
Rubber band ligation: The principle of ligation with rubber bands is to encircle the base of the hemorrhoidal anal cushion with a tight rubber band. The tissue cut off by the rubber band dies and is replaced by an ulcer that heals with scarring. It can be used with first-, second-, and third-degree hemorrhoids and may be more effective than sclerotherapy. Symptoms frequently recur several years later but usually can be treated with further ligation. The recurrence of symptoms may be less with ligation than with sclerotherapy.
The most common complication of ligation is pain, which may occur slightly more often than with sclerotherapy, but it tends to be mild. Bleeding one or two weeks after ligation occurs occasionally and can be severe. Bacterial infection may begin in the tissues surrounding the anal canal (cellulitis). Rarely, the infection spreads to the tissues within the pelvis and results in an abscess, or the infection may enter the bloodstream (sepsis). Infectious complications may be more common in patients who have defective immune systems, for example, from AIDS, cancer, chemotherapy, or severe diabetes.
Heat coagulation: There are several treatments that use heat to kill hemorrhoidal tissue and promote inflammation and scarring, including bipolar diathermy, direct-current electrotherapy, and infrared photocoagulation. Such procedures kill the tissues in and around the hemorrhoids and cause scar tissue to form. They are used with first-, second-, and third-degree hemorrhoids. Pain is frequent, though probably less frequent than with ligation, and bleeding occasionally occurs. Sclerotherapy, ligation, and heat coagulation are all good options for the treatment of hemorrhoids.
Cryotherapy: Cryotherapy uses cold temperatures to obliterate the veins and cause inflammation and scarring. It is more time consuming, associated with more posttreatment pain, and is less effective than other treatments. Therefore, this procedure is not commonly used.
