Sclerotherapy is one of the medical procedures for the treatment of hemorrhoidal disease. It involves sclerosing the hemorrhoids on an outpatient basis.
What is sclerotherapy for hemorrhoids?
Sclerotherapy is one of the medical procedures used to treat hemorrhoidal disease. It involves sclerosing the hemorrhoids on an outpatient basis. Sclerotherapy of hemorrhoids is a hemorrhoid sclerotherapy. It is used to treat symptomatic hemorrhoids. Since the procedure is usually performed on an outpatient basis, it is one of the most common methods of treating hemorrhoidal disease. Sclerotherapy is used for first- and second-degree symptoms, which are among the milder cases of hemorrhoids. Before treatment, it is first determined whether the symptoms are actually caused by hemorrhoids. Thus, other causes such as an anal fissure may also be responsible for the pain, which in turn require a different therapy.
Function, effect and goals
Sclerotherapy of hemorrhoids is one of the minimally invasive procedures. Because the tissue being sclerosed is largely insensitive to pain, the patient does not require anesthesia. Two different methods are used to treat first-degree hemorrhoids. These are sclerotherapy according to Blond and Hoff and sclerotherapy according to Blanchard. Sclerotherapy according to Blond and Hoff is also known as intrahemorrhoidal sclerotherapy and was introduced in 1936 by the physicians Kaspar Blond and Herbert Hoff. A proctoscope, which is a special endoscope, is used for this procedure. Using the proctoscope and a connected syringe, the physician injects a sclerosing preparation into the tela submucosa. This tissue is located between the tunica muscularis and tunica mucosa. The sclerosing agent is usually a zinc chloride or alcohol solution. Their allergy risk is significantly lower than that of the quinine solution used in earlier times. The physician can determine the correct administration of the injection via proctoscope by the bluish-glassy discoloration of the mucosa. Since there are no free nerve endings in the area of the tela submucosa, the patient need not fear any pain from the injection. It is common to perform intrahemorrhoidal sclerotherapy for four to six weeks in three to five sessions. The injection causes inflammation in the hemorrhoidal cushions, which in turn results in scarring of the tissue. In this way, the arterial blood supply decreases. In addition, the loosened mucosa becomes fixed. Sclerotherapy according to Blond and Hoff is particularly suitable for the treatment of first and second degree hemorrhoids. However, rubber band ligation according to Barron is considered more efficient for second-degree hemorrhoids. In Germany, intrahemorrhoidal sclerotherapy is the most common method of treating hemorrhoids. Blanchard’s sclerotherapy, also called suprahemorrhoidal sclerotherapy, has been used since 1928 and was named after Charles Elton Blanchard, its describer. In contrast to intrahemorrhoidal sclerotherapy, this variant involves the injection of phenol. This is dissolved five percent in peanut or almond oil. The physician administers the phenol solution into the neighboring arteries. Because in Germany the use of phenol is not exactly clarified legally, this method is often dispensed with in this country. Thus, the doctor must act on his own responsibility. The effect of sclerotherapy according to Blanchard is similar to that of the intrahemorrhoidal procedure. Thus, the substance administered elicits an inflammatory reaction that reduces blood flow and contracts the mucosa. Internationally, suprahemorrhoidal sclerotherapy actually represents the most common procedure for the treatment of hemorrhoidal disease. Independent sclerosing of hemorrhoids is not possible. For this reason, the treatment must always be performed by an experienced physician. Sclerotherapy does not involve the treatment of the entire corpus cavernosum. It is not considered useful because the corpora cavernosa are important for controlling bowel movements and contents. The cost of sclerotherapy of hemorrhoids varies and depends on the extent of the treatment. As a rule, 50 to 80 euros per session should be expected.
Risks, side effects and dangers
Although no pain is experienced during sclerotherapy of hemorrhoids and the complication rate is considered low, some side effects may still occur after sclerotherapy. These primarily include pain and feelings of pressure in the anal region. In addition, minor bleeding in the anal canal is possible. However, the complication rate is very low at 1 percent. Since the procedure is also minimally invasive, there are no major health risks to worry about. However, there are some contraindications. For example, sclerotherapy of hemorrhoids must not be used if the patient has chronic inflammation of the bowel, such as Crohn’s disease. Doctors also advise against performing the procedure in the case of acute hemorrhoidal inflammation, a tendency to thrombosis, and significantly elevated blood pressure. The same applies to the period of pregnancy. In such cases, another treatment method must be used. On the other hand, patients receiving blood-thinning medications can undergo sclerotherapy of their hemorrhoids because there is no risk of bleeding, provided the treatment method is performed correctly by the physician. A major disadvantage of hemorrhoid sclerotherapy is the significant recurrence rate, which is considered to be higher than average. Thus, in a period of three years, up to 70 percent of all patients will again develop a painful hemorrhoidal condition. To effectively counteract recurrences, it is therefore recommended that patients change their diet to a high-fiber diet with plenty of dietary fiber. In addition, the affected person should exercise regularly and reduce excess weight. Changing bowel movement habits can also be helpful.
