Hemorrhoid Treatment Level Three: In-Office procedures

February 5th, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

Sometimes, despite your best efforts, hemorrhoids problems do not go away. You might have tried modifying your diet and lifestyle, and you might have tried some topical remedies. However, a certain percentage of cases will not respond to these conservative measures. In these situations, simple in-office procedures are usually recommended. The persistent symptoms can include:

  • Bleeding
  • Itching, burning or pain
  • Prolapse of the hemorrhoids out of the anus, that is, the hemorrhoids bulge or hang out
  • Hemorrhoids can slide back inside the anus spontaneously or by manual replacement

Internal hemorrhoids are the ones that typically cause the symptoms describe above. These hemorrhoids are supplied by the same type of nerves that supply your intestines, therefore, they are not very sensitive to visceral, or bodily type pain. In general, this makes these procedures very well tolerated.

Rubber Band Ligation

This is by far the most common in-office procedure for the treatment of symptomatic hemorrhoids. In this procedure a special device applies constricting rubber bands around the hemorrhoids. The blood supply is cut off, and in about 1-2 weeks the hemorrhoids die and fall off on their own. Sometimes there is a small amount of bleeding when the dead tissue falls off.

In general, only 1-3 hemorrhoids are treated at a time. The success rate for this procedure is between 65-85%. Complications associated with rubber band ligation are rare. However, they can include pain, bleeding, blood clotting, infection and difficulty urinating.

If you take anti-coagulant medications like Coumadin or warfarin, it is important to inform your surgeon before the procedure because of the risk of bleeding. Also, it is best to avoid taking aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) during the 10 days that follow the procedure.


A sclerosant is a substance that is injected into the tip of the hemorrhoid, and this causes thrombosis, or in other terms, blood clotting. This process causes the bothersome hemorrhoid to shrink and die. It is generally less painful than rubber band ligation, but sclerotherapy has a lower success rate. There is also a much lower risk of bleeding associated with this procedure which can be important for persons on anticoagulation. Some sclerosants used in sclerotherapy are phenol, quinine urea or hypertonic saline.

Infrared Photocoagulation

In this in-office procedure, a special device is used to deliver heat in the form of infrared radiation. This is similar to sclerotherapy, but instead of a sclerosant, heat is used. Again, this causes the tissue to clot, shrink and die.


In electrocoagulation, an electric current is used to achieve the same result as infrared photocoagulation.


Treatment Level Three consists of simple and relatively painless in-office procedures. This treatment stage is for hemorrhoid problems that have not responded to topical medications and modifications in diet and lifestyle. The procedures are typically very well tolerated and safe.

Check out The H Doctor website. You will find many articles and videos that contain expert advice about hemorrhoid treatment and other important GI health topics.

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