subject: Conventional Approaches For Hemorrhoids [print this page] Despite thousands of years and millions of patients with pain, discomfort, and perceived embarrassment of hemorrhoids, the exact nature and cause of the condition is not clear, and the standard treatments are, at best, imperfect. There is not just one cure for hemorrhoids.
Dietary manipulation, vascular tonifying agents, injection sclerotherapy, cryotherapy, manual dilation of the anus, infrared photocoagulation, bipolar diathermy, direct current electrocoagulation, rubber band ligation, and hemorrhoidectomy are all standard considerations for the treatment of hemorrhoids.
The treatments can be grouped into conservative (diet and vascular tonification); non-excisional (sclerotherapy, cryotherapy, manual dilation, photocoagulation, diathermy, and electrocoagulation); and surgical methods (ligation and hemorrhoidectomy). Conservative methods with or without non-excisional treatments are preferred to surgical methods.
Some of the conventional approaches are not without potential complications. Injection sclerotherapy has resulted in cases of anaphylactic shock. Cryotherapy is cumbersome to perform and is associated with severe rectal pain and discharge. Manual dilation often requires general anesthetic and admission to the hospital.
If dilation is not performed carefully the results may be disastrous. Septic complications, including death, have resulted from rubber band ligation. Hemorrhoidectomy, although indicated in extreme cases unresponsive to conservative treatment, is extremely painful and requires a four to six week recovery.
The potential disadvantages of sclerotherapy, banding, manual dilation, and surgery have led to the development of a new generation of non-excisional techniques for the treatment of hemorrhoidal disease. Infrared photocoagulation, bipolar diathermy, and electrocoagulation are the most recent additions to the plethora of modalities to consider. These modalities aim to affect sclerosis of the vascular root and to fix the mucosa to the underlying submucosa and muscle.
There have been several studies showing the efficacy of these treatments as comparable to the semi-invasive therapeutic modalities. A study of 758 patients with symptomatic hemorrhoidal disease concluded that all three techniques, performed on an outpatient basis with little or no sedation, are effective modalities for first- and second-degree hemorrhoids. Moreover, direct current electrocoagulation was associated with less discomfort and fewer complications and can be effective in third- and fourth-degree hemorrhoids.
Although direct current electrocoagulation was utilized in 1867, and explained by Wilbur E. Keesey, MD in 1934, doctors today oddly consider it one of the new generations of modalities. A study of 120 patients using direct current electrocoagulation treating a total of 590 hemorrhoid segments reported all patients were successfully treated and remained symptom free at a mean duration of follow-up of 23 months.
The researchers concluded that direct current electrotherapy is an effective, painless, and safe outpatient treatment approach to all grades of internal and mixed hemorrhoid disease. Direct current electrotherapy has also been shown to be effective, safe, and cost effective in the treatment of chronic anal fissures associated with internal hemorrhoids.
One author suggests patients postpone evaluation of suspected hemorrhoids due to fear of the treatment modality, hospitalization, cost, and time of disability, leading to progression of the hemorrhoid or late diagnosis of serious gastrointestinal disease. Patients must be made aware of less invasive, relatively inexpensive, outpatient treatment options.
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