Coagulation is the process of clotting and destruction of blood vessels.  It has been used for many years in the treatment of hemorrhoids.  These treatments include cauterizing, heating probes, cryotherapy, and electric current.  All of these treatments are used to destroy the affected tissues.

The modern variation of these treatments is infrared coagulation.  This procedure uses an infrared beam to coagulate and destroy the affected tissue.  This treatment is very reliable, simple, and can be controlled accurately.

Advantages

1. The depth of tissue destruction can be easily controlled by length of exposure time
2. Short coagulation time (1 second) which allows for easy outpatient procedure
3. Finely focused beam, allowing other endoscopic procedures to be conducted alongside the infrared procedure
4. No non-contact coagulation
5. Does not cause interference with electromagnetic devices (pacemakers)
6. Used for 1 to 3 grade hemorrhoids
7. Can treat an infinite amount of hemorrhoids in one procedure
8. Less painful than other procedures (sclerotherapy and rubber band ligation)

Disadvantages

1. Expensive tools and necessary skill limit the choice of doctor that can perform this procedure
2. May require more than one treatment
3. Follow-up treatments after a year are normally required
4. Not as effective as rubber band ligation in the long term
5. Minor bleeding for 7 to 14 days after the treatment

Procedure and Recovery

A complete medical history and physical examination should be performed before a doctor considers you for this procedure.

That patient will lie down on his/her side with knees drawn up to the chest.  A proctoscope and infrared coagulator will be inserted into the anus.  The patient will feel a sharp prick or burning sensation when the coagulator is used.  The coagulator is applied to the base of the hemorrhoids and shoots bursts of infrared for 1 to 1.5 seconds.  A white spot marks the point of coagulation.  Blood vessels of the hemorrhoids are destroyed, which in turn decreases blood flow to the hemorrhoid.  Sometimes this whill immediately reduce bleeding.  Over the next week scar tissure forms, and the healing process will be completed.

Injection sclerotherapy is a procedure used to treat small hemorrhoids.  It is only used on internal hemorrhoids.  This fixative procedure uses a chemical that scars the tissue and stops the hemorrhoid blood supply.  The doctor injects this chemical into the vein inside the hemorrhoid.  The chemical hardens the vein and the sourrounding hemorrhoid tissue.  A scar forms in place of the hemorrhoid on the wall of the sphincter canal.  This scar in turn holds the nearby tissues and veins in place so they don’t bulge.  This procedure takes place in a doctor’s office.

Who Should Get It?
Doctors recommend sclerotherapy with:

• Small hemorrhoids that don’t react to home treatment
• Internal hemorrhoids that aren’t big enough for rubber band ligation
• Persistent bleeding from hemorrhoids
• People age 70 and older who are in poor health and could not receive more invasive surgery

Does it Work?
Sclerotherapy is comparable to rubber band ligation for small hemorrhoids.  That is about 60 to 80 percent effective.  However, sclerotherapy is not as effective as rubber band ligation for larger hemorrhoids.  Hemorrhoids often reoccur after sclerotherapy, but the procedure can be repeated.

Complications
Complications include:

• Painful burning if the injection is too close to the anus
• Allergic reaction
• Possible shedding of mucosa (rectal lining)
• Infection in the sphincter area
• Uncontrollable bowels or bladder
• Prostatitis (infection of the prostate)
• Bleeding

Post Procedure and Recovery

Bleeding from the anus can occur for 7 to 10 days after the procedure, especially when the hemorrhoid falls off.  Bleeding should be light and stop on its own, otherwise seek medical attention.  Over the counter pain relievers and shallow baths for 15 minutes at a time are fine.  To help reduce the risk of bleeding, don’t take nonsteroidal anti-inflammatory drugs (NSAIDs) for 4 to 5 days before and after the procedure.  Doctors recommend taking stool softeners to help ensure smooth bowel movements.  Straining during bowel movements increase the risk of hemorrhoids recurring.

For Your Consideration
Sclerotherapy is not an everyday procedure and is not as common as other fixative procedures.  The doctor’s expertise plays a large roll in the effectiveness of the procedure.  It is important to find an experienced doctor in this field.  It is also important to make changes in your daily diet to encourage smooth bowel movements.  If hemorrhoids persist, sclerotherapy can be repeated.  Other surgical treatments can also be tried.