The three most common alternatives for non-surgical procedures for treatment of hemorrhoids are rubber band ligation, infrared photocoagulation and sclerotherapy.

Rubber Band Ligation. A rubber band is placed around the base of the hemorrhoid inside the rectum. The band cuts off circulation, and the hemorrhoid withers away within 1-2 weeks, leaving an ulcer that later fibroses.

Rubber band ligation is the most widely used treatment for grade II and grade III hemorrhoids and is the standard to which other methods are compared. A band ligature is passed through an anoscope and placed on the rectal mucosa proximal to the dentate line.

“Pros”

• High success rate. Up to 80% of people who had this procedure said their symptoms improved
• Great long-term efficacy
• Repeat treatment for recurring symptoms is rarely needed

“Cons”

• Severe pain that sometimes does not respond to pain killers
• Bleeding from the anus
• Necrotizing pelvic sepsis is a rare, but serious, complication of rubber band ligation. It occurs 1-2 weeks after ligation, frequently in immune compromised patients, and requires prompt surgical debridement

Laser or Infrared Coagulation. These methods involve the destruction of hemorrhoids with laser or infrared light. Coagulation causes the hemorrhoidal tissue to harden and degenerate, and to form scar tissue as the area heals. Coagulation is generally effective for grade I, grade II, and some grade III hemorrhoids.

“Pros”

• Fewer and less severe complications than with rubber band ligation
• Simple, convenient and fast
• No serious complications

“Cons”

• Recurrence rates may be higher than with rubber band ligation

Sclerotherapy. A chemical solution is injected around the blood vessel to shrink the hemorrhoid.

I.S. is an alternative to rubber band ligation. Injection of sclerosing chemical substances like phenol in oil, polidocanol, concentrated NaCl solution, into the mucosa at the haemorroid’s origin, leads to tissue necrosis.

Rare major complications include pelvic infection and impotence, as result of incorrectly sited injection.

“Pros”

• Fewer and less severe complications than with rubber band ligation

“Cons”

• Recurrence rates may be higher than with rubber band ligation
• Urological complications
• Not suitable for anterior haemorrhoids

Hemorrhoidectomy (surgery). Occasionally, extensive or severe internal or external hemorrhoids may require removal by surgery known as hemorrhoidectomy.

“Pros”

• Highest success rate
• Best therapy for fourth degree hemorrhoids

“Cons”

• Highest rate of pain and complications. The complication rate is about 10-20%

OTC remedies. Over-the-counter creams and suppositories (e.g. Preparation H, Neo Healar) can help with the symptoms, but unlikely shrink the hemorrhoids.

“Pros”

• Can help with the symptoms like pain, swelling, itching
• No risks of treatment-related complications

“Cons”

• Unlikely shrink the hemorrhoids

Yury Bayarski is a contributing author of HealthAssist.net. More information about effectiveness and risks of hemorrhoids treatment methods and a comparison of hemorrhoids treatment methods is available on author’s website.

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