Treatment Overview

Injection sclerotherapy is a medical procedure used to treat small internal hemorrhoids. This fixative procedure uses a chemical that scars the tissues and cuts off the hemorrhoids' blood supply.

The doctor injects the chemical into the vein within a hemorrhoid. The chemical causes the vein to harden and the hemorrhoid tissue to die. A scar forms in place of the hemorrhoid on the wall of the anal canal. The scar tissue, which is firm and thick, holds nearby tissue and veins in place so they don't bulge into the anal canal.

The procedure is done in a doctor's office.

What To Expect After Treatment

Bleeding from the anus occurs 7 to 10 days after the procedure, when the hemorrhoid falls off.

Bleeding is usually slight and stops by itself.

• You may use mild pain relievers and sit in a shallow tub of warm water (sitz bath) for 15 minutes at a time to relieve discomfort.
• To reduce the risk of bleeding, avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) for 4 to 5 days both before and after injection sclerotherapy.
• Health professionals recommend that you take stool softeners containing fiber to ensure smooth bowel movements. Straining during bowel movements can cause hemorrhoids to recur.

Why It Is Done

Doctors recommend injection sclerotherapy in cases where:

• Small hemorrhoids do not improve with home treatment.
• Internal hemorrhoids are too small to treat with rubber band ligation.
• You have persistent bleeding from hemorrhoids.
• You are older than age 70 or are in poor health and would not be a candidate for more invasive surgery.

How Well It Works

For small hemorrhoids, injection sclerotherapy relieves symptoms about as well as rubber band ligation. However, sclerotherapy does not work as well as ligation for large hemorrhoids.

Hemorrhoids often recur after injection sclerotherapy. Treatments can be repeated.

Risks

Rare complications include:

• Painful burning if the injection is given too close to the anus, where pain-sensitive nerve endings are located.
• Allergic reaction to the injected chemical.
• Shedding of the rectal lining (mucosa), leaving an open wound (ulcer).
• Infection of the anal area.
• Inability to control bowels or bladder (incontinence).
• Infection of the prostate gland (prostatitis) in men.
• Bleeding.

What To Think About

Injection sclerotherapy is not a routine procedure and is done less often than other fixative procedures.

The success of injection sclerotherapy depends largely on the doctor's expertise in the procedure and your ability to make changes in your daily habits that will make passing stools easier. If hemorrhoids recur, injection sclerotherapy can be repeated, or another nonsurgical treatment can be tried.

Not all doctors have the experience or the equipment to do injection sclerotherapy. This may help you decide which procedure to choose. Ask your doctor which procedure he or she has done the most and how satisfied people have been with the outcomes.