Sclerotherapy for Hemorrhoids: Procedure Information

Introduction and Terminology of the Procedure

Sclerotherapy is a medical procedure primarily used to treat hemorrhoids, a common condition that can cause discomfort, itching, and bleeding. The procedure involves injecting a chemical solution, known as a sclerosant, into the hemorrhoidal tissue, causing it to shrink and eventually disappear. Terms such as “sclerosant”, “injection”, and “prolapsed hemorrhoids” are commonly used in this context. Data suggests that sclerotherapy is a popular treatment for hemorrhoids in the USA, with thousands of procedures performed annually. It’s recognized for its minimal invasiveness, quick recovery time, and high efficacy in treating certain types of hemorrhoids.

Indications for Sclerotherapy

Patients might consider sclerotherapy for hemorrhoids if they have persistent symptoms that do not improve with conservative measures. Indications include:

• Internal hemorrhoids: Sclerotherapy is often used to treat internal hemorrhoids that haven’t responded to simpler treatments.
• Bleeding hemorrhoids: If the hemorrhoids are causing significant bleeding, sclerotherapy may be indicated to control the hemorrhage.
• Prolapsed hemorrhoids: These are internal hemorrhoids that have dropped down during a bowel movement and do not retract back inside on their own.
• Non-resolving or recurrent hemorrhoids: Sclerotherapy may be the treatment of choice for hemorrhoids that do not improve with conservative measures or keep recurring.

It’s crucial to remember that the decision for sclerotherapy should be made in consultation with your healthcare provider, who will take into consideration your overall health, medical history, and the severity of your symptoms.

Pre-Op Preparation

Preparation for sclerotherapy requires some specific steps. Your doctor will provide detailed instructions, but generally, these include:

• Fasting: You may be asked to refrain from eating or drinking for a few hours before the procedure.
• Medication adjustments: Some medications might need to be temporarily stopped or adjusted. Always check with your healthcare provider regarding any medications you’re currently taking.
• Pre-operative clearances: Pre-op labs or imaging may be required to ensure your safety during the procedure.
• Transportation: As sclerotherapy can cause temporary dizziness, plan for a companion to drive you home post-procedure.
• Work or school notes: You may need a note for work or school, indicating you had a medical procedure.

Please remember that this is a general guide, and specific preparations may vary based on individual circumstances. As part of our comprehensive care, our telemedicine primary care practice can provide pre-operative clearances and arrange for pre-op labs and imaging.

Procedure Technique for Sclerotherapy

Sclerotherapy for hemorrhoids is a precise and delicate procedure. Though medical professionals are trained to carry it out effectively, it’s helpful for patients to have a clear, step-by-step understanding of what will happen. This section explains the technique without medical jargon, aiming for clear and comprehensive understanding.

Step 1: Preparing the Patient

Your doctor will first ensure that you are comfortable. You will be positioned lying down on your left side, with your right knee bent toward your chest. This position is known as the left lateral decubitus position, which allows the doctor easy access to the anal region. You may be given a local anesthetic to numb the area and reduce discomfort.

Step 2: Examination and Localization

The doctor will examine your anal region using a proctoscope, which is a short tube with a light at the end. This instrument allows the doctor to clearly see the hemorrhoids. After identifying the hemorrhoids, they will determine the best spots for the injections.

Step 3: Injection of the Sclerosant

Once the hemorrhoids are located, the doctor will use a special syringe with a fine needle to inject the sclerosant directly into the hemorrhoid. This substance causes the hemorrhoidal tissue to harden and shrink. Multiple hemorrhoids can be treated in one session, and each injection usually only takes a few seconds.

Step 4: Observing the Reaction

After the sclerosant has been injected, the doctor will observe the reaction of the hemorrhoid. It should begin to shrink almost immediately. If not, additional injections may be necessary.

Step 5: Concluding the Procedure

Once the doctor is satisfied with the results, they will remove the proctoscope. There are no stitches or bandages necessary with sclerotherapy. The entire procedure usually takes less than 30 minutes. After a brief observation period, you will be allowed to go home. You might feel some mild discomfort or have a sensation of fullness in your lower abdomen, but severe pain is uncommon.

Remember, it’s crucial to have open communication with your doctor throughout the procedure. Don’t hesitate to ask any questions you might have or voice any concerns. Your comfort and understanding of the procedure are paramount.

Duration of Sclerotherapy

The sclerotherapy procedure for hemorrhoids is typically a brief process, often completed within 30 minutes. The exact duration can vary depending on the number and size of hemorrhoids being treated.

Post-Op Recovery from Sclerotherapy

Recovery from sclerotherapy is generally quick. After the procedure, you will need to remain in the healthcare facility for about an hour for observation. During this time, your medical team will ensure that you’re comfortable and experiencing no adverse reactions.

Follow-up appointments with your doctor are typically scheduled about two weeks after the procedure. The purpose of these appointments is to assess the effectiveness of the procedure and check for any complications.

There is usually no need for specific physical therapy or rehabilitation after sclerotherapy. You might be advised to take it easy for a day or two, and most patients can return to work within a few days, depending on the nature of their job.

Dietary changes, such as increasing fiber intake, may be recommended to prevent constipation and minimize straining during bowel movements. Maintaining a healthy lifestyle can also aid in a smooth recovery.

Complete recovery from sclerotherapy can be expected within about two weeks. Remember, our practice offers extended hours, so we’re here for you if you need a work or school note, or any additional support during your recovery process.

Effectiveness of Sclerotherapy

Sclerotherapy is considered an effective treatment for hemorrhoids, particularly for smaller, internal hemorrhoids and bleeding hemorrhoids. Success rates for hemorrhoid elimination after sclerotherapy can be as high as 70-80%.

Certain factors can enhance the effectiveness of the procedure. Adhering to dietary changes, avoiding constipation, and minimizing strain during bowel movements can improve outcomes and reduce the likelihood of hemorrhoid recurrence.

In contrast, certain circumstances can potentially lower the effectiveness of sclerotherapy. For instance, patients with larger, external, or thrombosed hemorrhoids might not respond as well to this treatment, and alternative treatments may be recommended.

Overall, sclerotherapy offers a minimally invasive, highly effective treatment for hemorrhoids with a brief recovery time. It’s essential to discuss your specific situation with your healthcare provider to determine if sclerotherapy is the right treatment for your hemorrhoids.

Adverse Events with Sclerotherapy

As with any medical procedure, there are potential adverse events associated with sclerotherapy, although they are relatively rare. Some possible adverse events include:

• Rectal bleeding (2-5%): Minor bleeding may occur due to irritation or injury to the rectal tissues. This usually resolves on its own within a few days.
• Thrombosed hemorrhoids (1-3%): A blood clot may form in the treated hemorrhoid, causing discomfort or pain. This can be managed with medication or may require further treatment.
• Infection (<1%): Infection is extremely rare following sclerotherapy. If it does occur, it requires prompt medical attention and treatment with antibiotics.
• Anal stenosis (<1%): This is a narrowing of the anal canal that can occur due to scar tissue formation after sclerotherapy. It’s a rare complication that may require additional treatment.

The mortality rate for sclerotherapy for hemorrhoids is extremely low, close to 0%.

Alternatives to Sclerotherapy

There are several alternatives to sclerotherapy for treating hemorrhoids. These include over-the-counter creams and suppositories, oral medications, and dietary modifications to prevent constipation and straining. In terms of procedural alternatives, options may include rubber band ligation, infrared coagulation, or surgical hemorrhoidectomy for more severe cases. Your healthcare provider can discuss these options with you and help determine the best approach based on your specific situation and the severity of your hemorrhoids.

Experimental or Emerging Technologies

New treatments for hemorrhoids are continuously being researched. One such emerging technology is the use of Doppler-guided hemorrhoidal artery ligation, which involves using a Doppler probe to locate the arteries supplying the hemorrhoids and ligating them to reduce blood flow. This minimally invasive procedure can be an effective treatment for hemorrhoids, though more research is needed to establish its long-term efficacy and safety profile.

Conclusion

In conclusion, sclerotherapy is a safe, effective, and minimally invasive procedure for treating hemorrhoids, with a brief recovery time. Adverse events are rare, and there are several alternative treatments available. As always, discuss with your healthcare provider to determine the best treatment option for you. New treatments are also being researched, which promises future advancements in hemorrhoid management.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.