Hemorrhoids – Treatment Options

Medications can help relieve symptoms associated with hemorrhoids. Ointments which protect the skin like zinc oxide can prevent injury and reduce itching by forming a barrier over the hemorrhoids. Suppositories used for 7 – 10 days soothes irritation and lubricates the anal canal during bowel movements. Some of these products contain chemicals that can harm the anal tissues if they are used for a long period of time.
Ointments containing hydrocortisone 1% have the effect of reducing inflammation and itching. These products should not be used more than 2 weeks as they can cause atrophy (thinning) of the skin. If inflammation, thrombosis and irritation occurs treatment that is generally recommended is local application of ointments containing anti-inflammatory substances, painkillers or anesthetic substance, suppositories with similar content, and in cases associated with constipation laxatives.

Minimally invasive surgery techniques

Ligation with elastic bands. This process consists of applying a rubber band to the hemorrhoid. Circulation is interrupted and hemorrhoidal mucosa will necrosis (dies). Hemorrhoid is drawn into a tube, then strangled with a lever at the base to be mounted two rubber rings, so that the hemorrhoid dries, because it is not irrigated with blood anymore. After 7-10 days the hemorrhoid falls, leaving a small wound that scars quickly. This procedure is repeated every 2-3 weeks for the other hemorrhoids. This procedure requires no anesthesia.
Sclerotherapy. In this procedure the doctor injects a chemical solution inside hemorrhoids. This method is useful only for small hemorrhoids and is less effective than ligation with elastic bands. The results are often short-lived and require repeated treatment.
Laser photocoagulation. Clots the hemorrhoids and transforms them into fibrous scars. The method is very effective in small hemorrhoids but scar tissue can lead to stenosis or contrary to anal incontinence.
Infrared coagulation. This technique uses a probe that emits infrared radiation and thus produces heat. The probe is applied to the hemorrhoid causing clotting and scar tissue transformation. The method is used alone or in combination with ligation with elastic bands and is considered more effective than laser therapy for treatment of hemorrhoids.
Bipolar coagulation. Electrotherapy bipolar coagulation has a direct effect on the mucous membrane near the hemorrhoid. Bipolar probes are used to treat internal hemorrhoids that bleed.
Galvanic current therapy. Galvanic current therapy is defined as hemorrhoids dissolution (destruction) by chemical means and electrical power supplies using a chemical reaction on the hemorrhoidal mass. The procedure takes around 10 minutes. Galvanic current, completely painless, is applied directly into veins: the current, positive or negative, causes a thermal or a chemical reaction in the tissues, which either destroys or obliterates the hemorrhoidal mass. It is a simple and safe procedure and requires no anesthesia or hospitalization, no sequelae, and does not cause severe complications.
Cryotherapy (extreme freezing). A cryogenic device uses liquid nitrogen to freeze the hemorrhoid. This causes the affected tissue to die, so new tissue can grow in place. This technique has an increased effect when used to treat external hemorrhoids.
Hemorrhoidal artery ligation of branches of internal hemorrhoidal artery with hemorrhoids atrophy as consequence.

Surgery
Hemorrhoidectomy. Hemorrhoidectomy is surgical resection of hemorrhoids. Hemorrhoidectomy is indicated in case of complications of hemorrhoids like (bleeding, pain, formation of a clot, inflammation of the anus) or while other treatments (sclerosis, cryotherapy, ligation) failed. It is performed under general anesthesia or spinal anesthesia. Hemorrhoidectomy may be performed as a day procedure, but due to inadequate outpatient care and increased levels of pain after this procedure hospitalization is often required (3 days). Hemorrhoidectomy is the most effective and complete way to remove hemorrhoids, but is associated with the highest complication rate (ano-rectal region pain, temporary difficulty in emptying the bladder, urinary tract infections, etc.).
Hemorrhoidopexy. This procedure aims to reduce blood flow to hemorrhoidal tissue. Patients have less pain compared to those who experienced conventional techniques. Patients can return quickly to normal activities. Hemoroidopexia was associated with a higher risk of recurrence of hemorrhoids and rectal prolapse.

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