Common Office Treatments for Hemorrhoids
hemorrhoids are common problem, and as such there are a variety of treatments available depending on hemorrhoids’ severity, the expense you can afford, and how effective they are. Whether or not a particular treatment will work for a particular patient depends as well on whether or not the patient’s values support it. In general, office treatments used for hemorrhoids today are infrared photocoagulation, sclerotherapy, bicap coagulation, rubber band ligation, and, occasionally, cryotherapy.
Rubber band ligation is utilized treatment for second-degree internal hemorrhoids and usually an outpatient treatment. In this treatment, a small band is bounded to the base of the hemorrhoid thus impeding the circulation of blood supply to the hemorrhoidal mass.
It takes about two to seven days for the hemorrhoids, now shriveled, to dry up and die. Eventually, the hemorrhoids themselves, along with the rubber band, will simply fall off during normal defecation. This has a short recovery period, and rubber band ligation is also the most popular method of hemorrhoid removal because there’s little pain and no surgery involved.
With infrared photocoagulation, infrared radiation created by the coagulator clots tissue protein and evaporates the water from the cells. How extensive the treatment is is measured by how intensely and for how long the infrared radiation is applied. This also decreases blood flow to the hemorrhoidal tissue, but it is not effective for particularly large hemorrhoids or prolapsed tissue. Therefore, it’s most effective to treat Grade I or just into Grade II hemorrhoids. It’s more popular than rubber band ligation for hemorrhoidal treatment because it’s not as painful as rubber band ligation is.
Whether in the operating room or in the office, bipolar coagulation is generally the treatment of choice if precise coagulation needed. That’s because it penetrates less than the standard monopular cautery does, and it utilizes the same treatment theory such as that used by rubber band ligation or infrared photocoagulation. That is, the bicap probe is placed upon the apex of the hemorrhoid and left there for 10 minutes. It’s not especially effective for patients who have poor tolerance for pain, or for sitting still for that long; if patients don’t finish the session, its effect is reduced.
With the birth of rubber band ligation, sclerotherapy or also known as injection therapy is less used nowadays but it was a common treatment for hemorrhoids in the past. In the treatment, sclerosant (an irritating substance) is injected in the hemorrhoid to decrease vascularity and increasing fibrosis. Theoretically, like the other treatments, this will decrease blood circulating into the mass. Substances injected have customarily been sodium morrhuate or quinine urea.
As with other office treatments, the hemorrhoid is first located using an anoscope and then these substances injected at the mass’ apex, at the near anal rectal ring. Usually, this is not going to result in bleeding or other complications, but you may experience a dull ache after you’ve had this procedure for about a day or two.
Cryotherapy has been out of favor, as has sclerotherapy, with the advent of rubber band ligation. Previously, it was thought that freezing the apex of the anal canal would reduce anal cushion vascularity and induce fibrosis. However, the treatment causes a very unpleasant-smelling discharge, and it’s also quite painful. In addition, because it’s quite slow to heal, most medical practitioners have quit using it.