Internal Hemorrhoids
What is Sclerotherapy?
Sclerotherapy, also known as injection therapy, is a medical procedure used to treat small internal hemorrhoids. Sclerotherapy involves the injection of a hardening agent into the base of the hemorrhoid that cuts off circulation. The fixative procedure uses a chemical or sclerosant that irritates the surrounding tissues. There are many types of sclerosants such as phenol in almond oil, and saline solutions. But they all have the same effect: They cause a low-grade inflammatory reaction which scars the vein and mucosal tissues, collapses the vein walls, and causes the internal hemorrhoid to shrivel. The scar tissue, which is firm and thick, holds the nearby tissue and veins in place so they don’t protrude into the anal canal. Sclerotherapy is performed in a doctor’s office.
Advantages of Sclerotherapy for Internal Hemorrhoids
- Easy and Inexpensive: Sclerotherapy us easy and inexpensive to perform, as it is done on an out patient basis. There is also no costly anesthesia or lengthy hospital stay required.
- Fast Relief of Internal Hemorrhoids: In general, the patient should be symptom free in about seven to ten days after the procedure. At this time, the shriveled hemorrhoid will fall off during a normal bowel movement. Also, patients who have undergone Sclerotherapy will not be likely to develop another internal hemorrhoid for at least twelve months.
- Can Be Performed On the Elderly: Sclerotherapy is a popular choice for elderly patients who have fragile internal hemorrhoids.
- Can Be Used On Multiple Internal Hemorrhoids: Unlike other medical procedures, like Rubber Band Ligation, Sclerotherapy can be performed on up to three internal hemorrhoids per injection treatment.
Disadvantages of Internal hemorrhoids -Sclerotherapy
- Not As Effective on Large Internal Hemorrhoids: Sclerotherapy has a high likelihood of failure for large hemorrhoids and should not be used in these cases
- Not A Internal Hemorrhoid Cure: Sclerotherapy is not a cure for hemorrhoids. And although most patients will not experience another hemorrhoid for at least twelve months after the treatment, it is still possible for hemorrhoids to return at any time.
Internal hemorrhoids -Sclerotherapy Performed?
Your health care provider will likely advise you to defecate shortly before the treatment, as having a bowel movement right after therapy may disperse the sclerosant and reduce its effectiveness. The anal canal will then be lubricated and a local anesthetic and pain killer will be administered to the area. Your doctor will help you get into position for the procedure, lying on your left side with knees drawn to the chest and buttocks projecting over the edge of the table. A proctoscope with a wide bore will then be inserted into to anal canal to illuminate the internal hemorrhoids to be treated.
Your health care provider will inject the sclerosant at the base of the internal hemorrhoids, above the dentate line, where little or no pain will be felt. The dentate line separates the insensitive columnar epithelium from the sensitive squamos epithelium. So, if you feel pain when the doctor inserts the needle, it is possible that the injection site is incorrect. The needle will be inserted about one to two centimeters deep, parallel to the anal canal. About four millimeters of sclerosant will be slowly injected, allowing time for it to disperse into the tissue. After the injection is complete, the needle will be held in place for about two minutes to avoid bleeding or leakage of the sclerosant. It will then be slowly withdrawn to facilitate sealing of the puncture.
Sclerotherapy Recovery
Mild aching and discomfort is common after the procedure, and can be treated with conventional or herbal pain relievers. Your health care provider may prescribe a lubricant suppository and a stool softener to prevent any straining during bowel movements that might disperse the sclerosant or aggravate internal hemorrhoids. You may experience rectal bleeding approximately seven to ten days after the procedure when the internal hemorrhoid falls off. The bleeding should be minimal and will stop on its own.
Risks of Internal hemorrhoids -Sclerotherapy
Serious complications from Sclerotherapy are rare, occurring only about 0.02% of the time. They are usually the result of improper technique. Complications can include retention of urine, painful burning in the anus, allergic reaction to the sclerosant, shedding of the rectal lining, infection of the anal area, incontinence, infection of the prostate gland (in men), or painful blood clot formation.
Who Should Try Sclerotherapy?
Sclerotherapy should only be used on small, first or early second degree internal hemorrhoids. Second degree internal hemorrhoids in which the prolapse is slight or barely noticeable respond well to this treatment. However, as the internal hemorrhoids becomes larger, the chances of success become smaller with Sclerotherapy.
Who Should Not Try Sclerotherapy?
Sclerotherapy should not be performed if you have third degree internal hemorrhoids because the risk of developing an acute prolapse or painful blood clot is very high. Large second degree internal hemorrhoids also do not respond well to this treatment.
Sclerotherapy should not be used when other anal or rectal conditions, such as inflammatory bowel disease or ulcerative colitis, exist as this treatment may cause severe bleeding or the formation of ulcers. Anal fissures and fistulas are also contraindications to Sclerotherapy.