Sclerotherapy of hemorrhoids

Hemorrhoid sclerotherapy is a relatively new treatment format. Despite this, it is already in consistently high demand. The fact that the intervention is classified as a minimally invasive procedure adds to its popularity.

The effectiveness of the manipulation is confirmed by the reviews of patients who successfully got rid of a dangerous pathology in just this way. They also note that recovery after therapeutic measures usually lasts much less than with excision during surgery.

Bloodless technique

Sclerotherapy is also sometimes referred to as sclerotherapy. Manipulation involves the destruction of the connection between the hemorrhoid and the source of its origin. Removal is carried out according to bloodless tactics, which allows you to successfully shorten the rehabilitation period, returning the patient to his usual way of life in a week.

The essence of the method is to introduce a special drug into the lumen of the lesion, which gave the name to the method – a sclerosant. The drug causes an inflammatory process in the vein, which provokes adhesion of the walls of the vessel. Some time after the injection, the walls overgrow, which stops the natural flow of nutrients to the nodule. The latter, with a lack of oxygen and other substances, gradually dies off. It comes out naturally during the next bowel movement.

Surgeons used this treatment regimen two hundred years ago. Only instead of safe sclerosing compounds, more aggressive components were used. Most often it was ethyl alcohol or a solution of carbolic acid. Today, there are pharmacological preparations that are better tolerated by the body, and also do not carry many possible side effects.

The main medical indication for sclerotherapy is diagnosed hemorrhoids of internal nodes at the first or second stage of development. Unlike most other minimally invasive analogues, sclerotherapy works with small formations. It is their excision that occurs most productively.

Occasionally, sclerotherapy is prescribed to eliminate third-degree nodules, but with such a diagnosis, the predicted effectiveness drops several times. If a pathology is found in a person at the fourth stage, then injection assistance does not act as monotherapy. It is made part of an integrated approach, using pharmacological effects to prepare for the removal of the lesion.

Advantages and disadvantages

The most valuable positive quality of the presented procedure is safety for the victim. This is explained by the simplicity of intervention and the involvement of only licensed drugs. All of them have proven that they do not have a negative impact on the internal organs and surrounding healthy tissues. From the side of patients, the method was highly appreciated due to its painlessness.

Compared with the need to endure pain during the healing of an open wound surface after surgery, sclerotherapy significantly benefits. The victim will only experience a slight burning sensation during the insertion of a thin needle. Other benefits include:

• the ability to recover on an outpatient basis;
• extended list of indications;
• the onset of improvement in well-being almost immediately;
• the ability to treat several nodules with one intervention;
• relatively low cost.

Moreover, the exact price is announced by the attending physician after deciding on the amount of intervention for one session. The cost of rehabilitation therapy is also taken into account. Manipulation is applied even in relation to elderly patients, for whom all other alternatives are contraindicated. The reason for this is the fragility and fragility of blood vessels. With the injection method, this has no significant effect.

Among the relative shortcomings, the inability to work with large formations is distinguished. Also, the injection will not cope if the proctologist diagnosed the victim with an external form of the disease, or a combined one. But even if everything goes well, it is worth remembering that sclerosis only helps to cope with the symptoms of the disease, and does not remove the true root cause of the lesion. A person will have to follow preventive measures to eliminate the risk of relapse.

They involve changing lifestyles for the better. This applies to maintaining an active image with a decrease in the number of hours spent in a sitting position. It will be useful to reconsider the usual diet.

Medical Contraindications

Before sending the patient to undergo the procedure, the proctologist sends him for a detailed examination, which will eliminate hidden latent diseases.

The main prohibitions are: exacerbation of the course of the disease, thrombosis, severe bleeding, diagnosed anal fissures or fistulas.

All patients who, during the visualization of the problem area, could not clearly define the boundaries of inflammation and the node itself, will have to look for an alternative approach. This applies to the combined form of the course of the disease, when it is impossible to distinguish between external and external nodules.

When choosing a method of treating patients with hemorrhoids, it is advisable to use the following classification of chronic hemorrhoids:

• I st. – the release of scarlet blood from the anus without prolapse of hemorrhoids;
• II Art. – prolapse of hemorrhoids with their independent reduction into the anal canal (with or without bleeding);
• III Art. – periodic prolapse of hemorrhoids and the need for their manual reduction into the anal canal (with or without bleeding);
• IV Art. – constant prolapse of hemorrhoids along with the mucous membrane of the rectum, the impossibility of their reduction into the anal canal with the help of manual assistance (with or without bleeding).

Sclerotherapy of hemorrhoids is most effective in stage I. With an increase in the staging of the disease, the number of good results decreases and the number of relapses increases. Sclerotherapy does not allow to achieve a radical cure of patients with manifestations of hemorrhoidal disease, and good treatment results are observed only in 20% of patients.

Relative contraindications also include pregnancy and lactation. It is better to wait for more favorable circumstances. Separately, it will be necessary to conduct a preliminary allergic test in order to insure the patient against possible anaphylactic shock.

Step by step technique

Despite the fact that sclerotherapy does not apply to surgical operations, before its execution, you still have to undergo preliminary training. A cleansing enema is required, given approximately two hours before the appointment.

Sometimes an enema is allowed to be replaced with pharmaceutical drugs. But the list of medicines allowed to be taken, their dosage and rules of use should be clarified with the attending physician in advance.

The patient is placed on a medical couch, asked to pull his legs to his stomach. In this position, it will be more convenient for him to withstand the entire time allotted for the injection. But if it turns out that the person is not too comfortable in the standard position, then you can place the patient on his side or ask him to take a knee-elbow position. Before starting the intervention, the area is thoroughly disinfected and a special gel with an anesthetic effect is applied. As an injection tool, a special syringe with a thin needle is used, which makes it possible to reduce pain during the injection.

To obtain optimal access to the affected area, the surgeon inserts an anoscope into the anal canal. The syringe with the collected sclerosing solution is injected through the anoscope, directed to the hemorrhoid.

After the introduction of the drug into the area of ​​blood supply to the problem area, it begins to have a rapid effect. To increase the effectiveness, the agent is injected above the dentate line. It is she who is called upon to separate the epithelium insensitive to pain from the sensitive part of the squamous epithelium.

If during the procedure a person experiences pain, then this indicates that the injection is done incorrectly. The technique of its implementation involves the introduction parallel to the anal passage to a depth of no more than two centimeters. For a smooth distribution of the drug solution, it must be administered very slowly.

After the introduction of all the liquid from the syringe, the needle is left inside for a few more minutes. This forethought helps reduce the risk of bleeding and also blocks backflow.

The effect of the drug on the walls of blood vessels begins with the induction of an inflammatory reaction, which contributes to their gluing, which contributes to the replacement of the affected areas with connective tissue, through which blood does not enter the hemorrhoidal node along with oxygen, which guarantees its arbitrary safe rejection.

After sclerotherapy, the patient remains under the supervision of medical personnel for about an hour. At the end of this period, he goes home, while following the usual regimen with only minor restrictions.

They include a ban on vigorous physical activity and heavy lifting for three weeks.

The expected normal phenomenon will be minor pain, which can be stopped with analgesics. They are prescribed by the attending physician, taking into account the characteristics of the organism of the ward, as well as the results of his examination.

Puffiness after manipulation passes relatively quickly, with a gradual decrease in the feeling of discomfort and inflammation in the anus. To control the dynamics of recovery, the patient is advised to come back for an appointment in about two weeks.

Patients who decide on a minimally invasive operation are almost always satisfied with the results. The nodes quickly decrease in size, which guarantees a significant relief of well-being. If several lesions were found in the victim, then they can be removed in stages, several pieces per procedure. Between sessions, it is recommended to maintain at least a week break, which is enough for a full recovery.

Dangerous factors

In most cases, non-invasive intervention is satisfactorily tolerated by patients, subject to the requirements of careful preparation. Complications occur extremely rarely and most often they are associated with a violation of the procedure for administering the drug, or medical errors.

To prevent such a negative outcome, it is recommended that the procedures be performed by a qualified specialist.

With the development of complications, it will be expressed in:

• pain;
• bleeding.

The first option indicates a violation during the administration of the drug. When diagnosing the cause of bleeding, the time factor should be taken into account. Bleeding immediately after the procedure may indicate damage to the nearest vessel with the node. Stopped blood loss quite easily and quickly.

It is more difficult to cope with bleeding that has opened after a few days. It indicates the formation of an ulcer, which developed as a result of a violation of the dosing of the drug.

One of the options for complications is possible when the sclerosing material enters the anal vein. To indicate this will be too easy administration of the medicinal liquid. Also, the patient will complain of an unpleasant aftertaste in the mouth, pain in the liver.

In men, a complication may be the ingress of a pharmacological agent into the prostate gland with prostate adenoma, or with a physiologically large size of the prostate gland.

With such a clinical picture, the consequences can be the most unpleasant. The degree of damage directly depends on the amount of the substance that has entered the specified area, as well as on the route of its administration. After such a complication, urinary retention may develop, followed by a complication, classic prostatitis.

With a large affected area and the volume of injected fluid, infertility or a purulent inflammatory process may develop, due to the rapid formation of an abscess.

However, it must be emphasized that the rate of any complications in sclerosing is less than one percent. If you go through full training in advance and choose a qualified proctologist, you can avoid all of the above.

Sources of