Sclerotherapy (injections)

Sclerotherapy might be considered as a treatment for grade 1 or grade 2 hemorrhoids. In this procedure, a proctoscope is gently inserted into the anus. A proctoscope is a short tube with a light on it which the doctor can use to look at the membranes lining the anus. With the help of the proctoscope, a liquid containing drugs such as quinine, polidocanol or zinc chloride is then injected into the area around the enlarged hemorrhoids. The aim of this procedure is to shrink the hemorrhoids by damaging blood vessels and reducing the blood supply to the hemorrhoids. It usually needs to be carried out several times in order to treat all of the enlarged hemorrhoids. The injections are typically given every few weeks.

After sclerotherapy, some patients experience bleeding, mild pain, pressure, or the feeling that there is something in their back passage. In rare cases this procedure can also lead to swelling or infections. Sometimes a painful blood clot (thrombus) forms in the anal region. In many people, the hemorrhoids grow again after two to three years.

Rubber band ligation (banding)

This approach is mainly used in the treatment of grade 2 hemorrhoids. It’s also used for smaller grade 3 hemorrhoids, though. In rubber band ligation (also simply known as “banding”), the doctor first gently inserts a proctoscope into the anus. With the help of this instrument, he or she then places a small rubber band – only a few millimeters wide – around the base of the enlarged hemorrhoid. The band cuts off the blood supply to the hemorrhoid, which then shrinks and dies after about three to five days. The dead tissue and rubber band fall off and leave the body in the stool, without you noticing it. This procedure generally has to be repeated in order to treat all of the enlarged hemorrhoids, usually after a few weeks.

Studies have shown that rubber band ligation has some advantages over other surgical procedures for the treatment of grade 2 hemorrhoids. The patients experienced less pain after the procedure and were able to return to work sooner. Possible complications following the procedure include pain, bleeding, thrombosis or abscesses. And in many people the hemorrhoids grow bigger again after this procedure, too.

Hemorrhoidectomy (hemorrhoid removal)

In this kind of operation, the enlarged hemorrhoids are removed (“ectomy” means “removal”) using instruments like scissors, a scalpel or a laser. In some approaches the wound is left open afterwards, in others it is partially or completely closed with stitches. These types of surgical techniques are referred to as "open," "partially open," or "closed." Leaving the wound partially or completely open has the advantages of fewer stitch-related complications and fewer hematoma (bruising) problems. One disadvantage is that it takes longer for open wounds to heal.

Regardless of which operation they have, most patients experience pain in their anal region afterwards. Bowel movements and sitting may hurt as a result. These problems can usually be treated with painkillers. Other problems that may arise include bleeding after the operation, wound infections, abscesses, narrowing of the anus (anal stenosis), and – rarely – fecal incontinence. Fecal incontinence is the inability to control bowel movements.

Stapling

Stapling is a more recently developed technique, typically used in the treatment of grade 3 hemorrhoids. This procedure involves first removing some of the enlarged hemorrhoid tissue, and then “stapling” the remaining tissue to the lining of the anus again.

Recent research suggests that people who have this procedure experience less pain afterwards compared to people who have a hemorrhoidectomy. They were also able to return to everyday activities sooner. But stapling was found to have a disadvantage too: the hemorrhoids grew bigger again sooner after the procedure, and also came out of the anus more often. So, compared to hemorrhoidectomy, it might be necessary to repeat the stapling procedure sooner. Side effects like itching or bleeding were just as common following stapling as they were following other kinds of surgery.

Sources

• Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev 2006; (4): CD005393. [PMC free article: PMC8887551] [PubMed: 17054255]
• Joos AK, Herold A. Hämorrhoidalleiden. Neue konservative und operative Therapien für ein weit verbreitetes Leiden. Der Gastroenterologe 2010; 5: 326-335.
• Lan P, Wu X, Zhou X, Wang J, Zhang L. The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systematic review and meta-analysis of ten randomized control trials. Int J Colorectal Dis 2006; 21(2): 172-178. [PubMed: 15971065]
• Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA et al. Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids. Cochrane Database Syst Rev 2005; (3): CD005034. [PMC free article: PMC8860341] [PubMed: 16034963]
• Simillis C, Thoukididou SN, Slesser AA, Rasheed S, Tan E, Tekkis PP. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 2015; 102(13): 1603-1618. [PubMed: 26420725]

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.