• More than ten million people visit a physician in the U.S. each year with symptoms of hemorrhoids. Three out of four people will develop hemorrhoids at some time in their lives. While many people associate hemorrhoids with painful surgery, only a small percentage of patients actually require surgery. New comfortable office treatments have taken the fear out of hemorrhoids. This pamphlet has been prepared to help you understand them.
• Hemorrhoids are swelling in the rectum or anal area that may protrude through the anus on straining. They usually contain enlarged veins and are most common in people over the age of 50.
• Hemorrhoids can often be felt as a swelling in the area of the anus. There may be soreness, bleeding, discharge or itching.
• Hemorrhoids are often found in people who either sit or stand a lot or who have low fiber diets or poor bowel habits. Avoid straining or extensive sitting on the toilet. A diet rich in fluids, fruit, vegetables and fiber is desirable. If symptoms develop, see your doctor without delay.
• There are two different types of hemorrhoids: “Internal” hemorrhoids develop inside the anus. The most common symptoms are bleeding during bowel movements or protrusion through the anus upon straining. “External” hemorrhoids develop around the anus and can be a firm lump or lumps around the anus.
• When treated early, hemorrhoids usually disappear within a week or two. By increasing fiber and fluids in your diet, your stool with soften thereby promoting more regular bowel movements. It also helps to eliminate excessive straining and to take warm baths.
• Most painful external hemorrhoids will respond to rest and warm sitz baths. Within a week the pain should subside. The firm lump should completely recede within 4-6 weeks. If pain is severe, the physician may decide to make a small incision under anesthesia and remove the clot to provide immediate relief.
• Infrared Coagulation (IRC) is the most widely used office treatment for hemorrhoids and is preferred over other methods because it is fast, well-tolerated by patients, and virtually problem-free. A small probe contacts, the area above the hemorrhoid, exposing the tissue to a burst of infrared light for about one second. This coagulates the veins above the hemorrhoid causing it to shrink and recede. The patient may feel a sensation of heat very briefly, but it is generally not painful. Therefore anesthetic is usually not required.

Advantages

The advantages of infrared coagulation are:

1. The depth of tissue destruction can be finely tuned by adjusting the exposure time.
2. Brief coagulation time (approximately 1 second), allowing for quick outpatient procedure
3. Finely focused beam, allowing other endoscopic procedure to be conducted alongside the infrared procedure
4. Does not cause non-contact coagulation that occurs with laser treatment, which can lead to unwanted destruction of surrounding tissues
5. Does not cause interference with electromagnetic devices such as pacemakers
6. Can be used for grade 1 to 3 hemorrhoids
7. No limit on the number of hemorrhoids treated in on session
8. Less painful than sclerotherapy or rubber band ligation
9. May be effective in patients who do not respond to other treatments, such as sclerotherapy

Disadvantages

The disadvantages of infrared coagulation are:

1. Expensive apparatus and required skill limits the choice of physician that can effectively perform this procedure
2. Multiple treatments may be required
3. Follow-up treatment after one year are usually required
4. Long-term result not as good as rubber band ligation
5. Minor bleeding may occur between 1 to 2 weeks after the treatment

Procedure

1. A complete medical history and physical examination is performed. Patients that take anti-coagulation medicines or drugs that thin the blood may need to stop taking them before the treatment to prevent bleedings. Anorectal examinations, including digital rectal examination, proctoscopy or sigmoidoscopy should be performed to evaluate the scope and grade of hemorrhoids.
2. The patient is laid down on one side, with knees drawn up to the chest.
3. A lubricated proctoscope and the infrared coagulator is inserted.
4. The patient is warned that a sharp prick or burning sensation will be felt as the infrared is used. The probe is applied to the base of the hemorrhoids and infrared bursts of approximately 1 to 1.5 second are applied.

A small white spot marks the point of coagulation. Beneath this point, the blood vessels of the hemorrhoids are destroyed, resulting in decreased blood flow to the hemorrhoids and sometimes immediate reduction of bleeding. Over the following week or two, scar tissue will form and the healing process would be completed.