Other treatments

Causal treatment of hemorrhoidal disease ranges from out-patient procedures to surgical excision, depending on the severity of the disease.

In sclerotherapy, a sclerosing liquid is injected into the base of a small bleeding internal hemorrhoid to stop the blood circulation. This technique is used to treat Grade I or II hemorrhoids on an out-patient basis. It is usually painless and should only be used in individuals whose bowels are otherwise healthy, but not during pregnancy, in Crohn's disease, or thrombosis or if the hemorrhoids are inflamed. Relapses may occur in approx. 70 percent at short term and 30 percent of patients four years after the initial injection of a sclerosing agent.

A rubber band ligation is an out-patient technique applied to Grade II or III hemorrhoids. The tissue at the top of the hemorrhoids is tied with a rubber ring. Once the blood flow has been cut-off, the hemorrhoid usually shrinks and dies in about a week. The procedure itself takes only a few minutes, and one to three sessions may be required.

Surgical techniques are becoming increasingly patient-friendly
For advanced stages of hemorrhoidal disease, hemorrhoidectomy may be an option. Various methods are available.1 The less of the sensitive anoderm is removed during surgery, the better the fine adjustment of anal closure afterwards.

  • The standard procedure described by Milligan-Morgan involves the excision of enlarged hemorrhoidal nodes with mucosa and anoderm. To promote optimal drainage, the wound remains open after surgery.
  • Ferguson hemorrhoidectomy is similar to the Milligan-Morgan technique except that the skin is closed with a running suture.
  • Submucosal reconstructive hemorrhoidectomy according to Parks is a method for treating advanced hemorrhoids with anal prolapse and external hemorrhoids.
  • The Fansler-Arnold method is used for advanced hemorrhoids with an anal prolapse. In addition to removing the hemorrhoids it also includes reconstruction of the anal canal.
  • Longo’s procedure, or stapled hemorrhoidectomy, involves stapling hemorrhoids into their original position. The procedure is usually less painful than standard surgery but recurrence is more important than after hemorrhoidectomy.



1Sneider EB, Maykel JA. Diagnosis and management of symptomatic hemorrhoids, Surg Clin North Am. 2010 Feb;90(1):17-32.