External hemorrhoids represent distended vascular tissue in the anal canal distal to the dentate line. Persons with thrombosed external hemorrhoids usually present with pain on standing, sitting or defecating. Acutely tender, thrombosed
external hemorrhoids can be surgically removed if encountered within the first 72 hours after onset.
These methods are used to shrink and destroy the hemorrhoidal tissue. The doctor will perform the procedure during an office or hospital visit.
A number of methods may be used to remove or reduce the size of internal hemorrhoids.
Some of the techniques which are used:
1. Sclerotherapy
Sclerotherapy describes a procedure when a chemical is injected into the hemorrhoid, which causes it to scar and decrease in size.
Sclerotherapy is a medical procedure used to eliminate varicose veins and spider veins. Sclerotherapy involves an injection of a solution (generally a salt solution) directly into the vein. The solution irritates the lining of the blood vessel, causing it to swell and stick together, and the blood to clot. Over time, the vessel turns into scar tissue that fades from view.
2. Rubber band ligation
Rubber band ligation is a procedure in which the hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid. This treatment is only for internal hemorrhoids.
To do this procedure, a doctor inserts a viewing instrument (anoscope) into the anus. The hemorrhoid is grasped with an instrument, and a device places a rubber band around the base of the hemorrhoid. The hemorrhoid then shrinks and dies and, in about a week, falls off.
A scar will form in place of the hemorrhoid, holding nearby veins so they don't bulge into the anal canal.
3. Hemorrhoidectomy
Hemorrhoidectomy is a surgical procedure performed in the operating room with an anesthetic agent (general, spinal or local with sedation) where the whole hemorrhoid is removed (ectomy=removal). This is the most aggressive approach and there is a markedly decreased chance of the hemorrhoids returning. There is a potential for complications with this procedure; however, they occur less than 5% of the time. Complications include infection, bleeding, and stenosis where scarring causes the anus to narrow.
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4. Laser therapy
Laser therapies are medical treatments that use focused light. Laser light is a very special kind of light. Unlike most light sources, it is tuned to very specific wavelengths. This allows it to be focused into powerful beams. Laser light is so intense it can be used to shape diamonds or cut steel.
In medicine, lasers offer surgeons the ability to work very precisely. They can focus on a small area and damage less of the surrounding tissue. Patients who have laser therapy may experience less pain, swelling, and scarring than with traditional surgery. However, laser therapy is expensive. It may also require repeated treatments.
Laser therapy can be used to scar and harden internal hemorrhoids.
5. Stapled hemorrhoidectomy
Stapled hemorrhoidectomy is the newest surgical technique for treating hemorrhoids, and it has rapidly become the treatment of choice for severe hemorrhoid disease. Stapled hemorrhoidectomy is a misnomer since the surgery does not remove the hemorrhoids, but instead tightens abnormally lax and expanded hemorrhoidal supporting tissue that has allowed the hemorrhoids to prolapse downward. Stapled hemorrhoidectomy is faster than traditional hemorrhoidectomy, taking approximately 30 minutes. It is associated with much less pain than traditional hemorrhoidectomy and patients usually return to normal activities and work sooner.
6. Cryotherapy
Cryotherapy utilizes cold temperatures, delivered via liquid nitrogen, to cause tissue injury and fixation. It has been largely supplanted by the minimally invasive procedures discussed above because of a worse efficacy and higher rate of complication.
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