Office Procedures for Internal Hemorrhoids

If lifestyle changes and home care haven’t provided enough relief for your Grade I, II, or III internal hemorrhoids, your doctor may suggest an “office-based procedure.” These are minimally invasive treatments performed in a clinic setting without the need for general anesthesia or a hospital stay ^[1][2].

The goal of these procedures is to reduce blood flow to the hemorrhoid and create a small amount of scar tissue, which anchors the lining of the anal canal and helps prevent further bleeding or prolapse ^[2][3].

POST-PROCEDURE WARNING: While bleeding is a known risk of procedures, seek emergency care if you experience heavy or continuous bleeding, pass large blood clots, feel dizzy, lightheaded, or faint, have severe worsening pain, develop a fever or chills, or are unable to urinate.

Note for Blood Thinners: Never stop taking prescribed antiplatelet or anticoagulant medications (blood thinners) without explicit instructions from the prescribing clinician. Doing so can trigger serious cardiovascular events.

Rubber Band Ligation (RBL)

Rubber Band Ligation is a widely used and preferred option for internal hemorrhoids that don’t respond to home care, especially when prolapse is a concern ^[1]. During this procedure, the doctor uses a small device to place a tiny, tight rubber band around the base of the internal hemorrhoid.

• How it works: The band cuts off the blood supply. Within about a week, the hemorrhoid and the band wither and fall off, typically during a bowel movement without you noticing ^[1].
• Effectiveness: RBL has strong track records for symptom resolution, frequently cited as highly effective in clinical trials. It is particularly successful at controlling prolapse ^[4][5]. Keep in mind that exact success rates vary based on the initial grade of the hemorrhoid and how a study defines success.
• The Trade-off: RBL can cause post-procedure discomfort. Many patients report some pain or a significant sensation of “fullness” or pressure in the rectum for 24 to 48 hours ^[5].
• Delayed Bleeding: It is important to know that delayed bleeding can occur several days to roughly two weeks after the procedure when the banded tissue finally separates.
• Repeat Treatment: It is common to need more than one session—up to 20% of patients may require repeat banding to achieve full relief ^[4].

Sclerotherapy

Sclerotherapy involves injecting a chemical solution (a sclerosant) directly into the tissue around the hemorrhoid.

• How it works: The chemical causes the tissue to shrink and shrivel over time. A modern version of this uses Polidocanol foam, which some clinics prefer over traditional liquid injections ^[3].
• Pros and Cons: Sclerotherapy is generally associated with less post-procedure pain than banding ^[5]. However, some data suggests it may be less effective at controlling significant prolapse compared to RBL ^[5].
• Recent Evidence: Some single-center studies have shown high success rates with Polidocanol foam, but these results may reflect specific clinic expertise and may not apply universally to every patient ^[3].

Infrared Coagulation (IRC)

Infrared Coagulation uses infrared light to create heat that seals off the blood vessels feeding the hemorrhoid.

• How it works: The doctor applies a probe that delivers short bursts of infrared energy. This creates a small burn that turns into a scar, shrinking the hemorrhoid ^[1][6].
• Best for Mild Cases: IRC is an option for Grade I and II hemorrhoids where bleeding is the main symptom ^[6]. It often involves minimal discomfort ^[2].
• Limitations: Its effectiveness drops significantly as the hemorrhoid grade increases. While it shows good improvement for Grade I disease, success rates fall drastically for Grade III hemorrhoids ^[6]. For this reason, RBL is usually preferred if your hemorrhoids are frequently prolapsing ^[2].

Comparing Your Options and Recovery

Choosing between these procedures often involves a trade-off between how well the procedure works and how much discomfort you are willing to tolerate during recovery.

Always discuss the availability of these treatments, the operator’s experience, and how your specific hemorrhoid grade affects your chances of success.