What Are Hemorrhoids?

Hemorrhoids, also known as “piles,” are swollen blood vessels in the lower rectum and anus. They can be internal (inside the anal canal) or external (under the skin around the anus). Common symptoms include painless bleeding during bowel movements, itching, discomfort, and, in some cases, prolapse of tissue.

When Is Injection Therapy Recommended?

Injection therapy (sclerotherapy) is a minimally invasive option for treating internal hemorrhoids, particularly:

• Stage I: Bleeding without prolapse.
• Stage II–III: Hemorrhoids that prolapse during straining but retract on their own or with gentle push-back.
• Patients who want to avoid or delay surgery.
• People with health conditions (e.g., heart disease, hypertension) that make surgery riskier.

How Does Sclerotherapy Work?

1. A sclerosing agent (a medicine that causes mild inflammation) is injected around the base of the hemorrhoid.
2. This triggers scar formation, which seals small blood vessels and shrinks the hemorrhoidal cushion.
3. Over weeks, the treated tissue retracts and the hemorrhoid symptoms improve.

Common agents include 5% phenol in vegetable oil (the most popular worldwide), sodium morrhuate, and other sclerosants. Why 5% phenol in vegetable oil?

• Low dose (10–15 mL) minimizes side effects.
• Vegetable oil base is easily absorbed, reducing local irritation.
• Phenol has antiseptic properties, reducing infection risk.
• Produces small scars for quick healing.

Step-by-Step: What to Expect

1. Preparation: Empty bowels and bladder before the procedure.
2. Positioning: You lie on your side or in a lithotomy position.
3. Anoscopy: A small scope (anoscope) gently opens the anal canal to expose the hemorrhoids.
4. Injection: A fine needle is inserted just under the mucosa (lining) at the dentate line (where internal hemorrhoids begin). 3–5 mL of 5% phenol solution is injected per hemorrhoid.
5. Confirmation: You may see a light pink bulge—this indicates proper placement.
6. Aftercare: You can usually go home the same day with instructions on pain control and stool softeners.

Benefits and Success Rates

• Quick outpatient procedure: No incisions or general anesthesia needed.
• High cure rate: Up to 80% of patients report significant symptom relief.
• Minimal downtime: Most return to normal activities within 24–48 hours.

Possible Side Effects and Risks

While generally safe, sclerotherapy can cause:

• Mild discomfort or cramping during injection.
• Transient bleeding or spotting.
• Rarely, local ulceration if the agent is injected too shallowly.
• Very rare complications like infection, deep tissue injury, or embolism (when injected into a blood vessel).

Contraindications: Who Should Not Have Injection Therapy?

• Hemorrhoids with thrombosis, active infection, or skin erosions.
• Previous severe reaction to sclerosing agents.
• External hemorrhoids alone (injection is for internal hemorrhoids).

Tips for a Smooth Recovery

• Stool softeners (e.g., fiber supplements) prevent straining.
• Warm sitz baths (10–15 minutes, 2–3 times daily) soothe discomfort.
• Avoid heavy lifting or straining for at least 1 week.
• Drink plenty of water and eat a high-fiber diet to keep stools soft.

FAQs

Q: Is the procedure painful?
A: You may feel a brief burning or cramping sensation during injection, but severe pain is uncommon.

Q: How soon will I feel better?
A: Many patients notice improvement within 1–2 weeks; full effect in 4–6 weeks.

Q: Can hemorrhoids return after injection?
A: Recurrence occurs in 10–20% of cases; repeat injections or other treatments may be needed.

When to See Your Doctor

Contact your healthcare provider if you experience:

• Severe pain or fever.
• Excessive bleeding or discharge.
• No improvement after 6 weeks.

Learn More and Support

• American Society of Colon and Rectal Surgeons: https://fascrs.org
• Colorectal Health Foundation: https://colorectalhealth.org
• National Library of Medicine – Hemorrhoids: https://medlineplus.gov/hemorrhoids.html