Hemorrhoids are enlarged, bulging blood vessels in and about the anus and lower rectum. Straining, exertion, pregnancy, and other activities can lead to bleeding, pain, itching and swelling of hemorrhoids.  Sometimes hemorrhoids make it difficult to get clean after a bowel movement and can lead to rashes and irritation around the anal area.  More severe hemorrhoids cause obstruction and stricture of the anal area making the process of having a bowel movement even harder and more discomforting.  Once hemorrhoids have become enlarged producing symptoms the patient often will need an intervention to “shrink” or remove the hemorrhoids before they can obtain relief.

Hemorrhoid treatment options

There are three major methods of treating hemorrhoids in the office; Infrared coagulation (Laser), Rubber band ligation, and Sclerotherapy.  All methods are essentially “painless” when performed by an appropriate physician.  Office treatments require no down time, can be performed during a normal office visit, require no special preparation, no anesthesia, and no medication.  These procedures can be done and you can go right back to work.  A surgeon trained in rectal surgery can determine which treatment method will produce the best results for your condition.

1. Infrared coagulation (Laser)- Using a small probe, a burst of infrared energy is applied to the hemorrhoid’s surface in an area where there is typically no sensation.  This removes a couple millimeters of tissue and requires repeat applications to produce results.  This can be effective for hemorrhoids that do not prolapse (bulge with bowel movements out of the anal canal).
2. Rubber band ligation - One of the most permanent in office procedures for the removal of symptomatic hemorrhoids. A small band is placed around the base of the hemorrhoid, above the area where there is sensation.  The band effectively will remove a large portion of the hemorrhoid, essentially leaving a smaller hemorrhoidal cushion.  This typically can begin to produce relief after the first application.  One band is placed per visit to decrease the chances of having any discomfort and bleeding.  Having multiple bandings performed can be as effective as a full, inpatient surgery for removal of a patient’s hemorrhoids.  This treatment when done right will not produce pain and will produce immediate results.
3. Sclerotherapy- An effective treatment for reducing bleeding internal hemorrhoids.  While in the office a small injection is made into the hemorrhoidal vessels which are above the area of normal sensation.  Over a period of time the hemorrhoid “hardens” and shrinks due to minor interruption of the blood supply.  Can be very effective for patients on blood thinning medication who bleed with bowel movements.
4. Hemorrhoidectomy – For the most severe of cases, your surgeon may recommend a hemorrhoidectomy which is a surgery performed in the hospital under general sedation.  Typically this has been regarded as a painful surgery, but recently has been improved through the use of a tool called the harmonic scalpel.  A harmonic scalpel hemorrhoidectomy uses ultrasound generated energy to gently remove the hemorrhoid, minimizing damage to underlying, sensitive tissue.  This both decreases bleeding after the surgery as well as any “collateral” damage through traditional surgery with electrocautery and sutures.  For most cases a surgery performed in this manner can be done on an “outpatient” basis without the need for an overnight hospital stay.