Hemorrhoids are a common condition that affects millions of people daily. Although they’re a common bodily function, it can have a significant impact on a person’s quality of life due to discomfort and pain. Whether they’re caused by lifestyle factors or other underlying conditions, the impact of hemorrhoids can affect multiple parts of a person’s life.
Luckily, there are a few options for those seeking relief, including sclerotherapy for hemorrhoids. Sclerotherapy is a minimally invasive procedure commonly used to treat vascular conditions and offers a targeted and efficient approach to managing hemorrhoids and their discomfort.
The procedure is typically performed in the doctor’s office, with almost no downtime, making it a convenient option for those seeking relief from hemorrhoid symptoms without the need for more invasive interventions.
What are Hemorrhoids?
Hemorrhoids are veins which reside inside and outside of the anus. They are organs just like lungs, heart, kidneys and spleen are organs. Hemorrhoids are venous cushions which have a blood supply (artery which pumps blood into the hemorrhoid) and a venous return (veins which return the blood to the body). They are a part of our anatomy just like our eyes, nose, ears, toes, etc.
We are born with at least 6 hemorrhoids, three within the anus (internal hemorrhoids) and three outside the anal opening (external hemorrhoids). Though we have theories as to the function of hemorrhoids, there is no real scientific evidence of their purpose. It is proposed that the function of hemorrhoids is to aid in keeping stool from leaking out of the anus.
When hemorrhoid veins become inflamed and enlarged they can become symptomatic. The blood pumped into the hemorrhoid is thin and normal, but when the blood enters the inflamed hemorrhoid the inflammatory proteins made by the body thicken the blood so it is difficult to leave the hemorrhoid. This is called chronic venous insufficiency (CVI). With CVI there is more blood leading into the hemorrhoid than returning to the body. Think of a water balloon on a faucet but the balloon has tubes allowing water to flow back to the system. If the water coming into the balloon becomes thick like maple syrup, more water will enter the balloon than will leave the balloon so the balloon becomes bigger. As hemorrhoids become larger they start to cause symptoms.
There are several reasons why hemorrhoid symptoms develop, such as:
- Straining during bowel movements due to constipation
- Urgency to have a bowel movement – diarrhea
- Sitting for long periods of time
- Obesity
- Pregnancy
- Aging
- Chronic bowel issues
- A family history of hemorrhoids.
Symptoms of hemorrhoids:
The symptoms of hemorrhoids include internal hemorrhoid symptoms and external hemorrhoid symptoms. Though patients may experience pain, this pain is a throbbing, aching, toothache type pain, which is different from a fissure pain that tends to be sharp.
Internal hemorrhoid symptoms:
- Throbbing, aching pain around the anus
- Itching
- Painless bleeding
- Anorectal pressure
- Prolapse, a protrusion outside of the anus
- Urgency or the feeling of having to have a bowel movement but no stool comes out
- Mucous discharge
- Necrosis; when the hemorrhoids become trapped outside the anus and the hemorrhoid tissue starts to die). This is a surgical emergency.
External hemorrhoid symptoms:
- Thrombosis; a clot within the hemorrhoid, which causes pain, itching and sometimes bleeding with clots, if the hemorrhoid ruptures. A painful swollen lump that looks like a purple grape is a thrombosed hemorrhoid. 95% of the time thrombosed hemorrhoids will resolve on their own and recurrence in the same spot is unlikely therefore only conservative therapy is needed.
- Necrosis; when the external hemorrhoid becomes thrombotic and due to the pressure in the hemorrhoid the tissue starts to die. This is a surgical emergency.
- Swelling without clotting
-Hemorrhoids can often be managed with lifestyle changes, dietary adjustments, and over-the-counter treatments such as topical creams, ointments, or suppositories.
-In more severe cases or when conservative measures fail to provide relief for internal hemorrhoids, medical procedures like sclerotherapy and rubber band ligation may be recommended by your proctologist.
What is Sclerotherapy?
In general terms, sclerotherapy involves injecting a fluid into a venous structure. It’s primarily used to help treat venous conditions such as malformations and varicose veins. The fluid works by irritating the inner lining of the blood vessel, causing it to seal and stick together.
Sclerotherapy for hemorrhoids involves injecting a sclerosing agent directly into the internal hemorrhoid. Overtime, this allows scar tissue to develop, effectively closing off the blood vessel. As a result, the blood supply to the hemorrhoids is decreased, leading them to shrink in size. Smaller hemorrhoids cause less pain, itching, and bleeding.
The residual scar tissue in the veins acts as a supportive structure for the surrounding tissue, lowering the likelihood of a hemorrhoid recurrence in the same area. Sclerotherapy, often performed during a single visit to the doctor’s office, is a proven, effective treatment for internal hemorrhoids.
Is Sclerotherapy for Internal Hemorrhoids Right For You?
Determining if sclerotherapy is the right treatment for you involves several factors and considerations.
- Symptom Severity: The extent and intensity of your hemorrhoid symptoms play an important role in determining whether sclerotherapy is right for you. If you experience persistent symptoms such as pain, itching, bleeding, or swelling, sclerotherapy might be considered.
- Diagnosis: A thorough diagnosis by a healthcare professional is essential in determining the type and severity of your hemorrhoids. Sclerotherapy is typically suitable for internal hemorrhoids that are not responsive to other treatments like dietary changes, topical medications, and suppositories.
- Medical History: Your medical history, including any past treatments for hemorrhoids or other relevant health conditions, will also be evaluated. Conditions such as blood clotting disorders or allergies to sclerosing agents may impact the suitability of sclerotherapy.
- Treatment Goals: Clearly defining your treatment goals is another factor. Sclerotherapy aims to alleviate symptoms associated with hemorrhoids and reduce their size. If your goal is to achieve symptom relief and shrink hemorrhoids without surgery, sclerotherapy could be a viable option.
The decision to undergo sclerotherapy for your internal hemorrhoids should be made in consultation with a qualified healthcare professional, such as a proctologist, who can assess your individual needs, preferences, and medical history.
What to Expect During a Sclerotherapy Procedure for Hemorrhoids
Before undergoing sclerotherapy for hemorrhoids, your proctologist will conduct a comprehensive review of your medical history and discuss the specifics of the treatment plan with you.
During the procedure, your doctor will inject a sclerosing agent directly into the internal hemorrhoidal tissue, typically using a fine needle. Since internal hemorrhoids lack nerve endings that sense sharp pain or temperature, the procedure is painless when performed correctly.
I can attest from personal experience as both a proctologist and a patient that sclerotherapy on internal hemorrhoids is not painful. I have had my internal hemorrhoids treated with sclerotherapy on 2 separate occasions, and did not experience discomfort.
The only restriction for the day of the procedure is to refrain from lifting objects weighing more than 30 pounds. There are no restrictions the following day. While the effects of the treatment typically happen within the first day, it may take up to two weeks to fully take effect.
Potential Side Effects and Risks
- Discomfort
- Bleeding
- Infection
- Allergic Reaction
Recovery Care
- Pain Management: Over-the-counter pain relievers such as acetaminophen can help alleviate any discomfort after the procedure, though it is very rare to need any type of pain medication post sclerotherapy of internal hemorrhoids. Your doctor may also recommend topical treatments or sitz baths to soothe the area.
- Diet: Eating a high-fiber diet and staying well-hydrated can help prevent constipation and promote regular bowel movements, which can aid in the healing process. There are many options on the market for your choosing. At Thousand Oaks Proctology, we recommend our own product – PERFECT P.O.O.P. RAW, VEGAN psyllium.
- Follow-Up: Your healthcare provider will schedule a follow-up appointment to monitor your progress and determine if any additional treatments or interventions are needed.
Other Treatment Options for Hemorrhoids
If you are uncomfortable with the idea or sclerotherapy or if it’s determined you’re not a good candidate, there are other conservative, natural treatment options available.
- Topical Treatments
- Dietary Changes
- Fiber Supplements
- Sitz Baths
- R.H.O.I.D. – AID (Micronized Diosmin)
The choice of treatment for hemorrhoids depends on factors such as the severity of symptoms, the presence of complicating factors, the patient’s preferences, and medical history. In our experience at Thousand Oaks Proctology, over 90% of patients agree to sclerotherapy as the first line treatment and will add PERFECT P.O.O.P. and R.H.O.I.D. – AID to help lengthen the time before the hemorrhoid symptoms return.
If you’re interested in seeing if sclerotherapy is right for you, contact our office to schedule an appointment. We’ll walk through your symptoms and goals to determine the best course of action.