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 of 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
Hemorrhoids 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.
