Hemorrhoid Treatment: Infrared Photocoagulation and Sclerotherapy

February 22nd, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

Mild to moderate symptomatic hemorrhoids often respond to simple changes in diet and lifestyle. For example, just avoiding reading on the toilet is sometimes enough to give complete relief. Or maybe an increase in fiber and water is all that is needed to get rid of hemorrhoid symptoms. In other cases, topical ointments or creams might be recommended.

When these conservative treatments fail, however, simple in-office procedures are usually recommended. Infrared photocoagulation and sclerotherapy are two of the more common procedures used by hemorrhoid treatment specialists.

What is Infrared Photocoagulation?

In this procedure your surgeon uses a special device that generates heat using infrared radiation. When this heat is applied to the problematic hemorrhoid, it creates an area that is burned and scarred. This allows for the hemorrhoid tissue to shrink back to its normal size and position in the body.

How is it performed?

First, you will probably be given an enema to cleanse the area to be treated. Then your surgeon visualizes the area with a device called an anoscope. A special applicator tip then delivers the infrared heat to the hemorrhoid site for about 1 to 2 seconds. This is repeated up to 3 or 4 times per hemorrhoid. Up to 3 hemorrhoids can be treated per session.

Does it hurt?

The internal hemorrhoid nerve supply is special in that it is less sensitive to pain when compared to the nerves of your skin, for instance. This makes infrared photocoagulation very well tolerated. In most cases no anesthesia is needed at all. In fact, it might be most painless in-office procedure for the treatment of symptomatic hemorrhoids. One drawback is that it can only be used to treat relatively smaller hemorrhoids.

What are the side effects?

Typically, infrared photocoagulation is very well tolerated, but rarely there is some pain involved. Bleeding is another potential side effect. Overall, the procedure is very effective, but rubber band ligation seems to have a higher success rate.


Sclerotherapy is similar to infrared photocoagulation, but instead of using heat, the hemorrhoid tip is injected with a sclerosant. Sclerosants also cause the hemorrhoid tissue to shrink and die. Some of the more common liquid sclerosants are phenol, quinine and hypertonic saline. One of the big advantages of sclerotherapy is the very low bleeding risk. Even if you are taking anticoagulants you can undergo sclerotherapy with no extra risk of bleeding. However, this procedure also has a lower success rate when compared to rubber band ligation.

On very rare occasions sclerotherapy can cause unwanted side effects such as inflammation, abscess formation, urinary retention or impotence.


For bleeding or other hemorrhoid symptoms, there are various modifications in diet and lifestyle and topical medicines that can be tried. When these methods fail, in-office procedures are usually recommended. Infrared photocoagulation and sclerotherapy are two safe and well tolerated procedures. These simple in-office procedures can bring relief to mild or moderate hemorrhoid symptoms.

Explore The H Doctor website. You will find many more articles and videos that give the best information available about hemorrhoid treatment and other important health topics.

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