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Hemorrhoid treatments vary in their expenditure, risk, and effectiveness. The approach to a specific treatment also depends on the patient’s belief and culture. Office treatments are made up of various methods short of surgical intervention. The generally used office treatments today are rubber band ligation, infrared photocoagulation, bicap coagulation, sclerotherapy, and not often, cryotherapy.

Rubber band ligation is utilized treatment for second-degree internal hemorrhoids and usually an outpatient treatment. In this treatment, a small band is bounded to the base of the hemorrhoid thus impeding the circulation of blood supply to the hemorrhoidal mass.

It takes about two to seven days for the hemorrhoids, now shriveled, to dry up and die. Eventually, the hemorrhoids themselves, along with the rubber band, will simply fall off during normal defecation. This has a short recovery period, and rubber band ligation is also the most popular method of hemorrhoid removal because there’s little pain and no surgery involved.

With infrared photocoagulation, infrared radiation is created by the coagulator; this clots tissue protein and removes water from the cells. The treatments measure will depend on how long the infrared is applied for and on how intense it is. This method is intended to reduce blood flow to the region, but it’s not really effective in treating large hemorrhoidal masses or in treating prolapsed tissue. For that reason, it’s most useful in the treatment of Grade I or “just entered” Grade II hemorrhoids. If effective, though, it’s more popular than rubber band ligation for treatment because it’s less painful than rubber band ligation.

In the operating room or in office treatment, if precise coagulation is necessary as it penetrates less than the standard monopolar cautery, bipolar coagulation is usually utilized. It also utilizes the treatment theory like that of the rubber band ligation and the infrared photocoagulation. On the apex of the hemorrhoid, the bicap probe is placed and left for ten minutes. The procedure has a bit difficulty to patients with poor tolerance who don’t finish the set time thus reducing its effect.

Sclerotherapy was once used very commonly with hemorrhoids, but has fallen out of favor with the advent of rubber band ligation. Sclerotherapy involves injecting an irritating substance into the hemorrhoid to increase fibrosis and decrease vascularity. Also known as “injection therapy,” sclerotherapy works by decreasing blood circulation into the hemorrhoidal mass. Typically, injections consist of quinine urea or sodium morrhuate.

Similar to the other office treatments, the hemorrhoids is first identified using an anoscope then the substance is injected at the apex of the mass at the near anal rectal ring. Although it will seldom result to bleeding or other complications, a dull ache will be experienced for about a day or two.

As with sclerotherapy, cryotherapy has fallen out of favor. In previous years, the apex of the anal canal was frozen with the theory that vascularity and fibrosis of the anal cushion would be reduced. However, the treatment was not very successful because it triggered the production of a “smelly” discharge. It was also quite painful and healed quite slowly, so that most medical practitioners subsequently abandoned it.