The exam was no fun. (I know, patients tell me.)  But when the creams don't work
anymore and the pain is chronic, it's time to take some action so you can get on with
life. Treatment works! (I know,
patients tell me WHAT A RELIEF!!!)

Rubber band ligation.
The principle of ligation with rubber bands is to encircle the base of the hemorrhoidal
anal cushion with a tight rubber band. The tissue cut off by the rubber band dies
and is replaced by an ulcer that heals with scarring. It can be used with first-,
second-, and third-degree hemorrhoids and may be more effective than
sclerotherapy. Symptoms frequently recur several years later but usually can be
treated with further ligation. The recurrence of symptoms may be less with ligation
than with sclerotherapy.

The most common complication of ligation is pain, which may occur slightly more
often than with sclerotherapy, but it tends to be mild. Bleeding one or two weeks
after ligation occurs occasionally and can be severe. Bacterial infection may begin in
the tissues surrounding the anal canal (cellulitis). Rarely, the infection spreads to the
tissues within the pelvis and results in an abscess, or the infection may enter the
bloodstream (sepsis). Infectious complications may be more common in patients who
have defective immune systems, e.g., from AIDS, cancer, chemotherapy, or severe

Heat coagulation
There are several treatments that use heat to kill hemorrhoidal tissue and promote
inflammation and scarring, including bipolar diathermy, direct-current electrotherapy,
and infrared photocoagulation. Such procedures kill the tissues in and around the
hemorrhoids and cause scar tissue to form. They are used with first-, second-, and
third-degree hemorrhoids. Pain is frequent, though probably less frequent than with
ligation, and bleeding occasionally occurs. Sclerotherapy, ligation, and heat
coagulation are all good options for the treatment of hemorrhoids.

Cryotherapy uses cold temperatures to obliterate the veins and cause inflammation
and scarring. It is more time consuming, associated with more posttreatment pain,
and is less effective than other treatments. Therefore, this procedure is not
commonly used.
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The vast majority of patients with symptom-causing hemorrhoids are able to be
managed with non-surgical techniques. In the practice of a surgeon adept at
managing hemorrhoids non-operatively, it is estimated that less than 10% of
patients require surgery if the hemorrhoids are treated early.

Occasionally, the internal portion of the anal sphincter is partially cut in an attempt
to reduce the pressure of the sphincter within the anal canal. This procedure is
rarely used alone, and there is concern about incontinence (loss of control) of stool
as a potential complication.

Non-operative treatment is preferred because it is associated with less pain and
fewer complications than operative treatment. Surgical removal of hemorrhoids
(hemorrhoidectomy) usually is reserved for patients with third- or fourth-degree

During hemorrhoidectomy, the internal hemorrhoids and external hemorrhoids are
cut out. The wounds left by the removal may be sutured (stitched) together (closed
technique) or left open (open technique). The results with both techniques are
similar. At times, a proctoplasty also is done. A proctoplasty extends the removal of
tissue higher into the anal canal so that redundant or prolapsing anal lining also is