Sclerosing Hemorrhoids aka Hemroids / Piles
You may have seen elsewhere on this site mention of sclerosis as a treatment for hemorrhoids. If you want to know more about what sclerosis of hemorrhoids is and what it can do for you, then this is the article for you.
We’ll look at the treatment of sclerosing hemorrhoids, what it is and what the risks are, as well as alternatives and the history of the sclerosing hemorrhoids therapy.
What does Sclerosing Hemorrhoids mean?
The word ‘sclerosis’ has an ancient Greek derivation, from an identical word that means ‘to harden’. It came into the English language through medieval Latin and Middle English, and refers to a process that results in hardening of a tissue.
In Middle English, the word ‘sclirosis’ meant a hard lump or tumour.
The process of sclerosis can be part of a disease (such as multiple sclerosis) or a deliberate procedure, as is the case in the treatment of hemorrhoids.
In the case of a deliberate procedure, it is also referred to as sclerotherapy.
What is the procedure for sclerosing hemorrhoids?
Sclerotherapy as a surgical treatment is used to reduce or remove abnormal veins in a variety of patients.
Sclerotherapy is safely used in children and young adults to treat congenitally deformed veins, and is used in adults for the treatment of unsightly or problematic veins such as are found in hemorrhoids and varicose veins.
Sclerotherapy is easily performed, as the treatment involves the injection of a chemical into the vein that gradually causes the walls of the vein to thicken and harden. This reduces the flow of blood through the vein, and with a small enough vein, will get rid of it altogether.
This process is a bit like forcing the vein walls to produce scar tissue, which is thick, tough and inflexible.
Sclerotherapy isn’t instant, as using something that caused a vein to collapse immediately would be risky and potentially painful, rather like causing an instant blood clot - instead, the chemical sets up a little inflammation in the area of the vein where it is injected, and the body’s natural response to this over several days is to form scar tissue in that area, with the thickening and hardening that goes with it.
Depending on where exactly the target vein is, an ultrasound probe might be used to direct the needle in accurately, although if the vein is near enough to the surface that might not be needed.
Sclerotherapy is a common treatment in older patients, who may have fragile veins that might not react well to alternative treatments such as rubber band ligation; another advantage of it is that several veins can be treated at once during the same procedure.
There are, as you might expect, many different drugs or agents used in sclerotherapy.
An example would be iodine, which was one of the first chemicals used in this way (see the history section later); another is phenol, which is a chemical found in almond oil.
Some modern agents are applied as a kind of foam, rather like you might use to clean a drain with - this helps the chemical act by blocking off the blood supply to the area of the vein in question and preventing the chemical being diluted and washed away.
If that having your blood vessels blocked off sounds alarming, remember that the point of sclerotherapy is to block the vessel off anyway, and having the foam stick to the sides of the vessel also helps the chemical get to work faster.
Using Sclerotherapy on Piles
Sclerotherapy on piles is a fast treatment that can usually be done as a day case in an outpatients department, and would be done under a local anaesthetic so that the small pain of the injection is removed.
The injection is applied to the base of the pile, so that its blood supply is cut off.
You would expect to go straight home afterwards, and the injection will work its course over the next few days; if it’s being done to treat piles, the injected pile will quickly shrivel and actually fall off at some point after a week or so.
If sclerotherapy is being done to treat varicose veins, you’d expect a similar result, and if it’s being done to treat unsightly veins in the skin (such as so-called ‘spider veins’ on the abdomen) you’d get almost immediate results.
Sclerotherapy is also a cheaper treatment for the hospital, it’s got a better immediate effect on patient well-being and there is a smaller risk of complications arising from the procedure.
But studies have shown that in the long term (over five years), these other surgical interventions are more likely to be effective, although obviously a lot depends on patient behaviour - life style, diet ...
Sclerosis, like most treatments for hemorrhoids, does not prevent them coming back at a later date.
The only long term cure for most hemorrhoids is to examine their cause, and consider dietary and lifestyle changes where appropriate. You will find plenty of information on the causes of hemorrhoids and what you can do to get rid of them for good elsewhere on this website, HemorrhoidsHemroids.com
Will sclerosing hemorrhoids treat my hemorrhoids?
Sclerosis is only really appropriate for small hemorrhoids.
If you are familiar with the grading system, then only grade one or small grade two piles are likely to benefit from the injection - that’s small, possibly bleeding hemorrhoids that do not hang out (prolapse), or only hang out a little during straining.
Larger blood vessels, as you might find in higher grade piles, are not suitable for sclerosis - the scarring that results isn’t likely to actually close the vessel off, and may even cause problems like thrombosis with the hemorrhoids.
Are there risks with sclerosing hemorrhoids?
Yes there are - all surgical procedures have risks attached to them, and it certainly isn’t something you can consider doing for yourself at home!
But there are very definite benefits and very few side effects with sclerosing hemorrhoids, so it can be an excellent course to follow.
Sclerotherapy is an extremely safe procedure, but in something like one in every five thousand patients (which is about 0.02% for those who like statistics) some complications do arise.
Most of these occur from the needle missing the vein and causing tissue damage or bleeding; the injection can also be painful, although if you experience pain during the procedure it should be halted and checked - it may be that the anaesthetic just needs a little more time to work, but it could also mean the needle has missed its mark and needs to be re-guided.
Rarely, the sclerotherapy injection of the drug misses the vein and the scarring occurs somewhere inappropriate.
The prostrate gland is sometimes the injured party in this case, and the complications that arise from that can be unpleasant, including the formation of abscesses, inability to pass urine or even infertility in extreme cases. Bear in mind, however, that this is extremely unlikely to occur.
Other risks with sclerotherapy include having an allergic response to the chemical used and damage to the surrounding skin resulting in unpleasant scarring, although this is extremely unlikely to be a danger in hemorrhoid treatment, more in the use of sclerosis to treat unsightly veins elsewhere on the skin.
If you are having your hemorrhoids done by sclerotherapy injection, your doctor should advice you of the exact risks involved.
What are the alternatives to sclerosing hemorrhoids?
Surgery is only really necessary for more serious cases of hemorrhoids that do not respond well to gentler treatments, or for those that are complicated by blood clots or by becoming twisted and strangled. It’s not really a first line treatment for most cases.
Sclerosis works best on the smallest hemorrhoids; the main alternative to sclerotherapy would be tying the base of the hemorrhoids off with tiny rubber bands to produce a similar effect, a surgical procedure known as rubber band ligation.
Larger or more serious hemorrhoids don’t respond well to sclerosis or ligation, so other options would have to be considered. Your doctor would discuss these with you if they were being considered.
A little History about sclerosing hemorrhoids
For those of you who are interested, sclerosis isn’t a new therapy.
Sclerosis has mostly been developed through the treatment of varicose veins, and the first recorded attempt was by a Swiss doctor, Dr Zollikofer, in 1682.
He used an injection of an acid to produce the results he wanted.
Over the next two hundred years, sclerotherapy was mostly neglected in favour of surgical treatments, mostly because the chemicals used had too many side effects. Iodine, quinine, carbolic acid, tannins and mercury salts were all used at various times, chemicals which to a modern ear all sound relatively alarming and toxic!
Because of this, surgical methods were usually used, particularly a technique of removing a varicose vein known as ‘stripping’ it.
But over the last 150 years, improvements in the qualities of sclerosing drugs have been such that it gained favour, especially once ultrasound had been developed as this allowed very accurate injections to be performed.
Sclerotherapy is now a mainstay option in the treatment of hemorrhoids and varicose veins, as well as other similar conditions.
Main write by Dr. James D. Hogg, (BSc Oxon, MBBS & BA Hons), medical doctor, and minor rewrite by D S Urquhart.
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