Patient information on the risks associated to proctological disorders. The latest proctology news, new diagnosis and treatment methods.
Sclerotherapy is a fixative procedure generally recommended for small type I or II internal haemorrhoids. Sclerotherapy supposes the use of a sclerosing agent, which scars the inflamed tissue, thus reducing the blood flow towards the haemorrhoid and attenuating both the cause and the symptoms of the haemorrhoids.
The conditions justifying the use of this method are specific. For instance, physicians will recommend the use of sclerotherapy in the case of patients who do not respond to home treatment or in the cases of internal haemorrhoids where another fixative procedure, called rubber-band ligation, is not suitable. Considering that rubber-band ligation requires that the haemorrhoids are large enough to allow for rubber-band ligation, sclerotherapy is used for small haemorrhoids.
Sclerotherapy is also recommendable for bleeding haemorrhoids or in the case of patients whose held condition does not allow for invasive treatment methods, such as haemorrhoidectomy. Sclerotherapy is not recommended for prolapsed or external haemorrhoids, which require intensive surgery.
Most hemorrhoidal cases may be treated by simple diet changes and intestinal transit improvement. Most cases do not require surgery or other treatments, except if the hemorrhoids are very large and painful. The purpose of the non-surgical hemorrhoid treatments, also called fixative procedures, is to reduce the blood supply to the hemorrhoid so it shrinks or goes away. The scar that forms in that site supports the anal tissue and helps prevent the reoccurrence of hemorrhoids.
Fixative procedures include rubber band ligation (hemorrhoid ligature using rubber rings) or the use of electricity, laser or heat to scar the tissue (coagulation therapy).
Surgery (hemorrhoidectomy) may be used in the case of large internal hemorrhoids associated to the presence of a few small hemorrhoids or in case the bleeding could not be controlled through treatment. Sometimes a combination of these procedures (e.g., a fixative procedure and a hemorrhoidectomy) is the most efficient hemorrhoid treatment.
Most types of haemorrhoids do not require surgery, which only represents an option in case of intensive pain.
External haemorrhoids are not generally treated by haemorrhoidectomy, except for the case of very large haemorrhoids or if you underwent an surgical intervention in the anal area for other conditions (such as internal haemorrhoids or anal fissures).
Haemorrhoidectomy is the surgical resection of the haemorrhoids. General anaesthesia or raquianaesthesia is used to avoid pain. The incisions are performed in the tissue surrounding the haemorrhoids. The protruding haemorrhoid vein is ligated to prevent bleeding, and the haemorrhoid is excised. The surgical plague may be sutured or left open. Sterile dressing is applied onto the wound. The surgical intervention may be performed with a knife, a power tool (electrocautery tool) or using laser devices.
There is a procedure using circular stapling to excise the haemorrhoids and suture the wound, without any incision. Through this procedure, the haemorrhoid is lifted and stapled back into the anal canal. This procedure is referred to as haemorrhoidopexy. People opting for this method may experience less pain than those opting for the traditional intervention, but it is, however, more costly and involves a higher relapse risk.
Rubber-Band Ligation of Haemorrhoids with rubber-bands is a procedure through which the basis of the haemorrhoid is ligated with rubber rings, this interrupting the blood flow towards the haemorrhoid. In order to perform this procedure, the physicians inserts an optical instrument (anoscope) into the anus. The haemorrhoid is pinched with a special instrument, and a device fits the rubber ring over the basis of the haemorrhoid. The haemorrhoid atrophies and falls off in approximately one week. A scar forms at the initial haemorrhoid site, so that the adjacent veins do not swell onto the anal canal.
The procedure is performed in a medical clinic. You will be asked whether the rubber bands are too tight. If the ligature causes pain, an anaesthetic can be injected into the haemorrhoid. After the procedure, you may feel pain and a fullness sensation in the lower abdomen or a fake defecation sensation. The treatment is limited to 1-2 haemorrhoids per sessions, if the procedure is performed in a medical practice. A larger number of haemorrhoids may be treated during the same session if the patient is under general anesthesia. The other haemorrhoidal areas will be treated after 4-6 weeks.
What To Expect After The Treatment:
Patients respond differently to this procedure. Some are able to resume their daily activities almost immediately (with the recommendation to avoid heavy lifting). Other may require 2-3 days of rest.
The pain is a common syndrome 24-48 hours after the ligation. You can use acetaminophen (e.g., Tylenol) and warm sitz baths to relieve discomfort.
In order to reduce the bleeding risk, avoid aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) for 4-5 days before and after the ligation.
Bleeding may persist for 7-10 days after the procedure, when the haemorrhoid falls off. The bleeding generally is light and tends to disappear by itself.
Physicians recommend the use of fibre-content laxatives and liquid intake in order to facilitate defecation. The pressure during defecation may cause haemorrhoid relapse.
The Importance of This Type of Treatment:
Rubber-band ligation is widely used in the treatment of internal haemorrhoids. If the symptoms persist after 3-4 treatment sessions, surgical intervention might be required. Rubber-band ligation cannot be used if the removal device is unable to grasp (vacuum, pull) a sufficient quantity of tissue. This technique is almost never recommended for IV degree haemorrhoids.
Rubber-band ligation is efficient in 7-9 out of 10 people opting for this technique. It is much less probable for the people opting for this treatment to require another technique, as compared to those using a coagulation treatment. Approximately 1 out of 10 people will require surgery.
Though rare, secondary effects may include:
● Severe pain that does not respond to the post-procedural painkilling methods. The rubber bands may be placed close to the anal canal area hosting the pain sensory receptors;
● Anal bleeding;
● Urinary retention;
● Anal infection;
Rubber-band ligation is regarded as the most effective non-surgical long-term internal haemorrhoid treatment method. As this treatment may cause pain, some people may refrain from it. Even though other treatment methods may be less painful, they might not be as efficient, and a less efficient treatment might need to be resumed in the case of a relapse.
Haemorrhoidectomy can provide better long-term results than the fixative procedures, such as rubber-band ligation. However, the intervention is more expensive, requires a longer recovery time and has a higher associated risk of complications.