Office Procedures

Office procedures treat selected internal hemorrhoids without an operating-room operation. They are considered when bleeding or prolapse remains bothersome after conservative care and the examination confirms a suitable internal target.

Procedure selection balances hemorrhoid grade, symptoms, recurrence, pain, and complications. External disease, fixed advanced prolapse, anticoagulant or antiplatelet use, immune status, prior procedures, and patient priorities may change the choice. [1]

Rubber band ligation

Rubber band ligation places a band above the pain-sensitive dentate line, causing the treated tissue to necrose, detach, and scar. It is commonly used for bleeding or prolapsing internal hemorrhoids. Pressure or a dull ache can occur; sharp severe pain may mean the band is too low or another complication is present.

Delayed bleeding can occur when treated tissue separates. Rare but serious pelvic infection may present with escalating pain, fever, urinary difficulty, or systemic illness and requires urgent assessment.

Injection sclerotherapy

Injection sclerotherapy introduces a sclerosant into internal hemorrhoidal tissue to promote vessel closure and fibrosis. Agent, technique, and suitability vary. Pain, bleeding, thrombosis, and rare abscess are possible complications. [1]

Infrared coagulation

Infrared coagulation applies controlled energy to internal tissue, producing coagulation and fixation. It is an option for selected lower-grade internal hemorrhoids. Recurrence may lead to repeat treatment or another approach. [1]

Selection and recurrence

No office procedure is best for every presentation. Rubber band ligation may offer stronger control for prolapse but can cause more post-procedure discomfort than some alternatives. Sclerotherapy or infrared treatment may be useful when anatomy, bleeding risk, or tolerance changes the balance. Recurrence is discussed before treatment because office care may need to be repeated. [1]

After the procedure

Instructions should cover expected discomfort or spotting, bowel management, medicines, activity, who to contact, and urgent warning signs. Persistent bleeding should not simply be assumed to be a normal procedure effect.