Medical Treatments for Hemorrhoids
An advanced or severe case of hemorrhoids often can only be treated by medical procedures. These treatments include:
Anal Dilation
Although this technique is no longer commonly used, when properly used, anal dilation can help relieve the pain and promote healing of hemorrhoids. In this anal dilation procedure, the anal sphincter muscle is stretched or dilated to prevent hemorrhoids from increasing rectal pressure, as well as to reduce the need of straining to pass stool.
Because of its potential side effect of fecal incontinence or anal leakage, this procedure not be used for eldery patients or those with weak sphincter muscle.
Rubber Band Ligation
Basically, the idea behind this method has not changed since Hippocrates tied thread around an internal hemorrhoid to cut off its blood circulation. Today, your doctor would use an applicator to apply a special rubber band onto the base of the hemorrhoid. The band will cut off blood circulation to the hemorrhoid, which will shrivel and fall off in about one week along with the band.
This medical procedure is usually done for bleeding internal and prolapsed hemorrhoids. It can be done without any special preparation, in your doctor's office. In case of multiple hemorrhoids, your doctor would normally ligate or band them one at a time over a period of time. Typically, separate hemorrhoids are treated about one month apart.
Because there are few nerve endings in the anal canal, this procedure is usually not painful. However, some people do experience discomfort and a dull ache after the procedure. To avoid further irritating the hemorrhoid, it is recommended that you drink plenty of water, eat a fiber-rich diet, and take a stool softener.
In rare instances, side effects and complications such as clotting of an external hemorrhoid and bleeding can happen.
Sclerotherapy or Injection Therapy
Sclerotherapy involves injecting a sclerosing or hardening agent into the base of an internal hemorrhoids. The sclerosing agent is basically a scar-producing chemical or saline solution that causes the vein walls to collapse and the hemorrhoids to shrivel up.
Unlike the rubber banding procedure, scerotheraphy can be applied to multiple hemorrhoids at once. It is often the preferred method for treating older men and women, whose veins are more fragile.
In very rare instances, sclerosed hemorrhoids can develop complications such as abscesses.
Cryosurgery or the Freezing Method
In this method, liquid nitrogen or nitrous oxide is used to cool a device called a cryoprobe to freezing temperature. The frozen tip of the probe is then touched to the hemorrhoid to freeze and destroy the tissue. Two or three weeks later, the hemorrhoid will shrink and fall off. Both internal and external hemorrhoids can be treated with cryosurgery.
A popular method twenty years ago, cryosurgery has fallen out of favor because it is painful and can cause many complications. For example, foul odor from the drainage from the treated hemorrhoid can last for weeks and requires the use of absorbent pads or napkins. The open wound can also become infected.
Electrocautery
In this method, electricity delivered from a probe is used to cauterize or burn off hemorrhoidal tissue. However, because of the heat involved, patients may feel some pain.
Laser or Infrared cautery
Hemorrhoid can also be destroyed by heat generated by a laser or infrared device. In this method, laser is used to coagulate the hemorrhoid and cause it to shrink. This method is an improvement over cryosurgery and electrocautery, because it provides better control over the depth of coagulation. Patients treated with laser also have less bleeding and post-operative drainage or discharge.
Hemorrhoidectomy or Hemorrhoid Surgery
Hemorrhoidectomy or the surgical removal of hemorrhoid, is usually done only on severe cases. It is recommended for prolapsed or thrombosed internal hemorrhoids, or large and painful external ones.
In this procedure, surgeons cut off the hemorrhoids using either scalpels or lasers, and sew up the cut with stiches. A small pad is then placed on the anus to absorb drainage and discharge.
Surgical hemorrhoidectomy requires anasthesia and hospitalization for three to ten days, followed by one to four weeks of bed rest at home. Pain killers and regular hot sitz baths are usually required to relieve the pain after each bowel movement, until six to eight weeks after the surgery.
Side effects from hemorrhoidectomy can include severe pain and bleeding, narrowing of the anal canal, tear in the anal canal, inability to defecate, and scarring. In very rare instances, the surgery can also destroy nerve endings that leave the patient unable to tell flatulence apart from the "call of nature".
Because of the expensive cost of surgery and the possible side effects, only a small fraction of hemorrhoids (less than 1%) are surgically removed.
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