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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

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

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

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

Sclerotherapy describes a procedure when a chemical is injected into the hemorrhoid, which causes it to scar and decrease in size.

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

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.

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.

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

The following are pictures of the stapled hemorrhoidectomy procedure.

Picture of Internal Hemorrhoids in Anal Canal

Picture of Hollow Tube Inserted into the Anal Canal and Pushing up the Hemorrhoids

Picture of Suturing the Anal Canal through the Hollow Tube

Picture of Bringing Expanded Hemorrhoidal Supporting Tissue into the Hollow Tube by pulling On Suture

Picture of Hemorrhoids Pulled Back Above Anal Canal after Stapling and Removal of Hemorrhoidal Supporting Tissue

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