Hemorrhoids (cont.)

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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Bhupinder Anand, MD

Surgery

A variety of surgical options exist for persistent pain or bleeding.

Rubber band ligation: Rubber band ligation of internal hemorrhoids can be done in the office. The surgeon places a couple of tight rubber bands around the base of the hemorrhoidal vein causing it to lose its blood supply. There may be some fullness or discomfort for 1-2 days after the procedure and a minor amount of bleeding may be experienced.

Sclerotherapy: Sclerotherapy describes a procedure when a chemical is injected into the hemorrhoid causing it to scar.

Laser therapy: Laser therapy can be used to scar and harden internal hemorrhoids.

Hemorrhoidectomy: Hemorrhoidectomy is a surgical procedure done 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. However, there is also an increase in the complication rate.

Stapled hemorrhoidectomy: Stapled hemorrhoidectomy is the newest surgical technique for treating hemorrhoids, and it has rapidly become the treatment of choice for third-degree hemorrhoids. Stapled hemorrhoidectomy is a misnomer since the surgery does not remove the hemorrhoids but, rather, the 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 earlier to work.

Regardless of the surgery, Sitz baths and dietary suggestions for increased roughage are usually recommended.