Sclerotherapy – Hemorrhoid Treatment

Sclerotherapy is a fixative procedure typically prescribed for treating small, internal, first or second degree hemorrhoids. The Sclerotherapy procedure employs a hardening chemical that scars the inflamed tissue, reducing the hemorrhoid’s blood-flow and thereby alleviating both the cause of the hemorrhoid and its symptoms. The conditions that warrant the use of the procedure is specific. For example, physicians will commonly prescribe Sclerotherapy for individuals who do not respond positively to home hemorrhoid treatments, or for internal hemorrhoids that are not readily amenable to treatment with another common fixative procedure called Rubber Band Ligation. Since Rubber band Ligation requires that the hemorrhoids be large enough to be physically tied off with at least one rubber band (two if possible), Sclerotherapy is typically used for hemorrhoids that are smaller in size and dimension. Other cases in which Sclerotherapy would be employed include treating hemorrhoids that bleed, or in cases where an individual’s health is not strong enough to risk invasive procedures such a Hemorroidectomy. Sclerotherapy is not appropriate for hemorrhoids that have become prolapsed, or externalized, in which case a more intensive surgical procedure would probably be recommended.

Sclerotherapy consists of injecting a chemical into the base of the hemorrhoid that actually hardens the tissue. There are a number of chemicals that are employed to produce this effect. The chemicals that achieve this are referred to as scelorosants, and include saline solutions and phenol, which is an extract of almond oil.

Whatever solution your physician chooses, it will produce similar reactions, with one objective: to produce sustained inflammation in the infected region, over a long enough duration, that scarring in the hemorrhoidal vein sets in. The scarring induces the vein to collapse and eventually shrivel and harden. The resulting scar will also act to reinforce the anus wall, and thereby ensure that the hemorrhoid does not bulge and reoccur, causing further symptoms or the need for continued treatment.

Sclerotherapy itself is a far less intensive procedure than other surgical interventions such as a Hemorroidectomy. With Sclerotherapy treatment, recovery time is shorter and the procedure threatens less risky side-effects; additionally, because the procedure can be done in a doctor’s office, it does not require a stay in the hospital. Sclerotherapy necessitates the patient adhere to strict protocol prior to, and after, the procedure has been performed. Typically, if possible, the patient is instructed to produce a bowel movement prior to the procedure, after which a lubricant if used in the anus, in addition to a topical anesthetic, to reduce pain or discomfort.

Sclerotherapy involves laying the patient on either their left or their right side, with their rectum protruding over the edge of the operating surface. The doctor will then inject the sclerotic chemical into the base of the hemorrhoid, above what is called the dentate line, which will reduce or eliminate any potential pain that will otherwise occur. Should immediate pain occur, it is likely that the physician has made a mistake and missed the site of injection. The actual injection is approximately 3 to 5 milligrams in size, and is administered slowly but steadily to allow for consistent absorption into the infected tissue. If performed correctly, Sclerotherapy should not cause the patient to suffer anything more slight than aches or pains, which can be treated with over-the-counter medication such as Tylenol; aspirin and NSAID’s, or non-steroidal anti-inflammatory drugs, should be avoided because of the risk of clotting or excessive bleeding.

Sclerotherapy can produce complications, about which your physician will educate you. Immediate bleeding indicates that during the procedure the injection site was missed and that the hemorrhoidal vein has been punctured. If this should occur, the procedure must be halted and pressure applied to the wound. Delayed bleeding frequently indicates that either the sclerotic dose administered was incorrect, or that instead of the base of the hemorrhoid receiving the injection, the mucosal layer beneath the hemorrhoid received the injection. In either case further attention is necessary to prevent still worse side-effects from setting-in. Other adverse side-effects can include allergic reaction to the sclerotic solution, sloughing, or shedding, of the mucosal lining in the rectum, inability to regulate bowel movements, or in males infection of the prostate gland. In the event one or any of these symptoms develop, consult with you doctor immediately.

Sclerotherapy typically produces results in approximately 7 to 10 days, at which time the hemorrhoid will shrink and fall off. The results frequently last up to 12 months. Given the swelling Sclerotherapy produces, no more than 3 hemorrhoids per session will be treated at a time. Bare in mind that because there is a high risk of failure treating larger hemorrhoids with Sclerotherapy, it is avoided in such cases in favor of Rubber Band Ligation or a Hemorroidectomy. Speak with your physician to properly educate yourself to all of the options available to you; and to ensure that rather than pursuing other fixative interventions, what is correct for you is in fact Sclerotherapy.

written by, David Gilbert

© 2009 H.I.C. Digestive Health

References – Sadick N, Sorhaindo L, Laser Treatment of Telangiectatic and Reticular Veins, Ch 16, p157. The Vein Book / editor, John J. Bergan, 2007. – William R. Finkelmeier, Sclerotherapy, Ch. 12, ACS Surgery: Principles & Practice, 2004, WebMD (hardcover book). – William R. Finkelmeier, Sclerotherapy, Ch. 12, ACS Surgery: Principles & Practice, 2004, WebMD

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