Monday, July 27, 2009

Common Treatments for Hemorrhoids in the Doctor's Office

By Richard Hill

Hemorrhoid treatments abound, but how effective, risky, and expensive they are varies. Whether or not you as a patient embrace a treatment also depends upon your culture and belief system. When you receive office treatments for hemorrhoids, these will usually not be surgical in nature. Most often, hemorrhoids are treated in the office with infrared photocoagulation, sclerotherapy, rubber band ligation, bicap coagulation and, infrequently, cryotherapy.

Rubber band ligation is utilized treatment for second-degree internal hemorrhoids and usually an outpatient treatment. In this treatment, a small band is bounded to the base of the hemorrhoid thus impeding the circulation of blood supply to the hemorrhoidal mass.

It takes about two to seven days for the hemorrhoids, now shriveled, to dry up and die. Eventually, the hemorrhoids themselves, along with the rubber band, will simply fall off during normal defecation. This has a short recovery period, and rubber band ligation is also the most popular method of hemorrhoid removal because there's little pain and no surgery involved.

With infrared photocoagulation, infrared radiation is created by the coagulator; this clots tissue protein and removes water from the cells. The treatments measure will depend on how long the infrared is applied for and on how intense it is. This method is intended to reduce blood flow to the region, but it's not really effective in treating large hemorrhoidal masses or in treating prolapsed tissue. For that reason, it's most useful in the treatment of Grade I or "just entered" Grade II hemorrhoids. If effective, though, it's more popular than rubber band ligation for treatment because it's less painful than rubber band ligation.

Whether in the operating room or in the office, bipolar coagulation is generally the treatment of choice if precise coagulation needed. That's because it penetrates less than the standard monopular cautery does, and it utilizes the same treatment theory such as that used by rubber band ligation or infrared photocoagulation. That is, the bicap probe is placed upon the apex of the hemorrhoid and left there for 10 minutes. It's not especially effective for patients who have poor tolerance for pain, or for sitting still for that long; if patients don't finish the session, its effect is reduced.

With the birth of rubber band ligation, sclerotherapy or also known as injection therapy is less used nowadays but it was a common treatment for hemorrhoids in the past. In the treatment, sclerosant (an irritating substance) is injected in the hemorrhoid to decrease vascularity and increasing fibrosis. Theoretically, like the other treatments, this will decrease blood circulating into the mass. Substances injected have customarily been sodium morrhuate or quinine urea.

All office hemorrhoidal treatment involves identifying the hemorrhoids first with an anoscope, and then injecting the substance at the hemorrhoidal mass' apex. Usually, this treatment doesn't cause any bleeding, but you may experience a dull ache or other slight pain for a couple of days.

Like the sclerotherapy, cryotherapy too has been out of the trend. Years back, the theory was that freezing the apex of the anal canal as a consequence will reduce vascularity and fibrosis of the anal cushions. The treatment triggered the production of a foul smelling discharge. It was also observed to be painful and it was related with slow healing thus it was abandoned by most medical practitioners.

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