How is internal hemorrhoidal disease treated?
Various treatments are available for internal hemorrhoidal disease. Not all people will require an office procedure or surgery.
For milder or occasional symptoms, the following treatments can help:
- Keep stool soft and regular by increasing the amount of fiber in your diet to 30 grams/day and, if needed, by starting a fiber supplement.
- Develop good toilet habits, such as not straining or sitting on the toilet for a long period of time. If you are constipated, a stool softener or laxative may be added after talking with your doctor.
- Take a warm tub or sitz bath to relieve more severe pain from bowel movements.
For more severe or chronic symptoms, other options are available. The best procedure for you depends on the size of the internal hemorrhoids and how severe your symptoms are.
Techniques for treating internal hemorrhoidal disease include:
- Rubber band ligation: Usually performed in the office without sedation, rubber band ligation involves placing rubber bands at the base of the internal hemorrhoid to cut off its blood supply, allowing it to fall off.
- Sclerotherapy: In an office setting, a sclerosing (chemical) agent is injected into the internal hemorrhoid to create scar tissue to fix it in place.
- Doppler-guided hemorrhoidal artery ligation: This surgical procedure, done in the operating room under general anesthesia, uses a special anal probe equipped with a Doppler device. Blood vessels leading to the internal hemorrhoids are identified and then tied off (ligated), causing them to shrink. The internal hemorrhoids can also be fixed in place with stitches.
- Stapled hemorrhoidopexy, or Procedure for Prolapse and Hemorrhoids (PPH): Also done in the operating room, a special stapling device removes a donut of the rectal lining, which then pulls the bulging internal hemorrhoids back into the anus.
- Excisional hemorrhoidectomy: The internal and, if appropriate, external hemorrhoids are removed by cutting them out.
- Infrared coagulation: Coagulation of the veins feeding the hemorrhoids can be done as an outpatient procedure in the office.
In most cases, a thrombosed external hemorrhoid does not need surgery. As the blood clot dissolves, the thrombosed external hemorrhoid shrinks. If needed, the clot can be removed or the thrombosed external hemorrhoid completely cut out. This minor procedure can usually be done in the office.