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.

People who read this also read

• Hemorrhoids. How are hemorrhoids diagnosed?
  How are hemorrhoids diagnosed? Most individuals who have hemorrhoids discover them in one of several ways. They either feel the lump of an external hemorrhoid when they wipe themselves after a bowel movement, note drops of blood in the toilet bowl or on the toilet paper, or feel a prolapsing hemorr...
• What causes hemorrhoids?
  It is not known why hemorrhoids enlarge. There are several theories about the cause, including inadequate intake of fiber, prolonged sitting on the toilet, and chronic straining to have a bowel movement (constipation). None of these theories has strong experimental support. Pregnancy is a clear caus...
• Hemorrhoids. What are hemorrhoids?
  What are hemorrhoids? A precise definition of hemorrhoids does not exist, but they can be described as masses or clumps ("cushions") of tissue within the anal canal that contain blood vessels and the surrounding, supporting tissue made up of muscle and elastic fibers. The anal canal is the last fou...
• Hemorrhoids. How are hemorrhoids treated?
  How are hemorrhoids treated? It is believed generally that constipation and straining to have bowel movements promote hemorrhoids and that hard stools can traumatize existing hemorrhoids. It is recommended, therefore, that individuals with hemorrhoids soften their stools by increasing the fiber in ...
• Hemorrhoid and Pregnancy
  Because of the pressure exerted by the growing fetus on the hemorrhoidal veins, pregnant women are highly susceptible to developing hemorrhoids. Increased levels of the female sex hormones can also weaken vein walls to make them more prone to hemorrhoids. Furthermore, constipation due to poor diet a...