Infrared Coagulation

Coagulation – or the process of clotting and destruction of blood vessels – has been used for decades in the treatment of hemorrhoids. These treatments include using heat (cauterizing or heating probe), using extreme cold (frozen probe in cryotherapy), and using electric current to destroy affected tissues.

A modern variation of coagulation includes the use of infrared beam. Unlike other forms of coagulations, this method is very reliable, simple to use, and can be controlled accurately.

Advantages

The advantages of infrared coagulation are:

1. The depth of tissue destruction can be finely tuned by adjusting the exposure time
2. Brief coagulation time (approximately 1 second), allowing for quick outpatient procedure
3. Finely focused beam, allowing other endoscopic procedure to be conducted alongside the infrared procedure
4. Does not cause non-contact coagulation that occurs with laser treatment, which can lead to unwanted destruction of surrounding tissues
5. Does not cause interference with electromagnetic devices such as pacemakers
6. Can be used for grade 1 to 3 hemorrhoids
7. No limit on the number of hemorrhoids treated in one session
8. Less painful than sclerotherapy or rubber band ligation
9. May be effective in patients who do not respond to other treatments, such as sclerotherapy

Disadvantages

The disadvantages of infrared coagulation are:

1. Expensive apparatus and required skill limits the choice of physician that can effectively perform this procedure
2. Multiple treatments may be required
3. Follow-up treatments after one year are usually required
4. Long-term result not as good as rubber band ligation
5. Minor bleeding may occur between 1 to 2 weeks after the treatment

Tissue destruction by infrared

A depth of 1 to 3 millimeters of tissue can be effectively coagulated by using a non-coherent, multi-spectral light infrared source. Radiation by infrared causes the temperature of the cellular tissues to rise above 100 C – effectively causing boiling of intracellular fluids and destruction of proteins.

Procedure

1. A complete medical history and physical examination is performed. Patients that take anti-coagulant medicines or drugs that thin the blood may need to stop taking them before the treatment to prevent bleedings.
   
   Anorectal examinations, including digital rectal examination, proctoscopy or sigmoidoscopy should be performed to evaluate the scope and grade of hemorrhoids.
   
   
2. The patient is laid down on one side, with knees drawn up to the chest
   
   
3. A lubricated proctoscope and the infrared coagulator is inserted.
   
   
4. The patient is warned that a sharp prick or burning sensation will be felt as the infrared is used. The probe is applied to the base of the hemorrhoids and infrared bursts of approximately 1 to 1.5 second are applied.

A small white spot marks the point of coagulation. Beneath this point, the blood vessels of the hemorrhoids are destroyed, resulting in decreased blood flow to the hemorrhoids and sometimes immediate reduction of bleeding. Over the following week or two, scar tissue will form and the healing process would be completed.