Sclerotherapy injection treatment
What is sclerotherapy?
In simple terms, sclerotherapy is the injection of a chemical solution into the area around the hemorrhoid resulting in a scarring reaction which makes the hemorrhoid gradually shrink or shrivel up over time. It is typically reserved for grades 1 and 2 internal hemorrhoids.
During hemorrhoid injections, a chemical solution called a sclerosant, is injected into the submucosa of the back passage (the area of tissue just under the inner lining of the bowel) rather than directly into the blood vessels . Injections are placed above the dentate line (this is the line or point where the outside sensitive skin becomes the inside less sensitive mucosa, and injecting above this point results in the injections being largely painless).
What does the treatment involve?
The procedure is undertaken by a doctor as an outpatient appointment. No preparation is required, and anaesthesia is not used.
After a proctoscope or endoscope (the tube-like devices a doctor might use to gain access to the inside of the bottom via the anus or bottom opening) is inserted, the doctor will be able to see and access the hemorrhoids. One of these devices is inserted into the anus to open up the anal canal to be able to see the hemorrhoids to be treated. A chemical solution is injected using a needle and syringe around the submucosal area where the haemorrhoid is located. The chemical traditionally used is phenol suspended in almond oil, although sometimes now suspended in groundnut oil. An alternative is 50% dextrose water. The sclerotherapy process gradually hardens (scleroses) the tissue around the hemorrhoid with the development of scar tissue, also called sclerosis. After 4-6 weeks the hemorrhoid should shrivel up. The name sclerotherapy derives from the sclerosing/scarring effect of the treatment or therapy; sclerotherapy literally means scarring treatment.
The treatment typically takes 5-10 minutes and 2-3 hemorrhoids can be treated at one time. Repeat treatments can be undertaken if necessary.
You will normally be asked to avoid any strenuous activity for the rest of the day following treatment. You will usually be able to resume normal activities the next day.
What are the risks with sclerotherapy injection treatment?
You may experience low level pain for a while but nothing that can’t be managed with over the counter painkillers. You also may have a little bleeding, but this is perfectly normal. Care must be taken in men as injecting towards the front of the body could affect the prostate gland. This could lead to symptoms, including prostatitis (inflammation of the prostate gland), haematospermia (blood in the semen), haematuria (blood in the urine), epididymitis (inflammation of the epididymis or sperm tube) and impotence (the inability to get an erection), although the latter is uncommon. Side effects are unusual, but the commonest following treatment, apart from mild pain, are ulcers affecting the anal mucosa, which typically heal without any specific treatment. More serious but rare complications include severe allergy to the nut oil the phenol is suspended in, rectal perforation (going through the bowel wall), rectourethral fistula (a connection between the rectum or bottom and the outflow tract of the bladder or urethra), hepatic abscesses (abscesses in the liver), life-threatening sepsis and abdominal compartment syndrome.
One study has shown that a high fibre diet works just as well as sclerotherapy, but without complications. In another study, immediately after sclerotherapy injection treatment had been performed, a haemorrhoidectomy was carried out and the hemorrhoids removed were examined under the microscope. There were no significant short-term changes seen in the treated tissue where the sclerosant had been injected.
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