Clinically, hemorrhoids usually present with bleeding, prolapse, pain (with thrombosis or ulceration), perianal mucous discharge, or pruritis. The complications of hemorrhoids are thrombosis, infection with inflammation, ulceration, and anemia.
Treatment is directed to control constipation, bleeding, prolapse and pain. Dietary measures like high fiber diet, Sitz bath, stool softeners, laxatives and various topical creams are advised for treating hemorrhoids. Ambulatory treatment for hemorrhoid comprises of injection sclerotherapy, rubber band ligation, Cryosurgery, Infrared coagulation and Ultrasonic Doppler guided transanal hemorrhoidal ligation. Surgical treatment comprises of open or closed hemorrhoidectomy and stapled hemorrhoidopexy.
Injection for piles: Injection sclerotherapy for piles is most commonly performed painless cure for piles without surgery. About 3 ml of sclerosant is injected in each piles. It causes fibrosis of the piles and fixation of the redundant mucosa. In trained hands the procedure is safe and complications are rare. Injection sclerotherapy has a low cure rate, but is a reasonable option for treatment of first and second degree piles with bleeding.
Band ligation for hemorrhoids: Major surgery for hemorrhoids like surgical excision (hemorrhoidectomy) or stapled hemorrhoidopexy (PPH procedure) can be often avoided in favour of more precise, often painless and outpatient methods of treatment. Variety of minimally invasive surgical techniques can now be offered to many patients as a feasible alternative to painful or costly major hemorrhoid surgeries. For patients with grade 2 and 3 hemorrhoids, Rubber Band Ligation is currently the most widely used in office procedure in the United States. Rubber band ligation is more helpful when combined with a sclerotherapy injection for prolapse.
In this procedure, a rubber band is applied to the base of the hemorrhoid to hamper the blood supply to the hemorrhoidal mass. The hemorrhoid will then shrink and fall off within 2-7 days. Rubber band ligation can be performed in an ambulatory setting. The procedure causes less pain and has a shorter recovery period than surgical hemorrhoidectomy. Its success rate is between 60% and 80%
Hemorrhoid band ligation