From the Guidelines
Rubber band ligation is the most effective and recommended treatment for lower gastrointestinal bleeding caused by internal hemorrhoids, with a success rate of 80% and 69% of patients being symptom-free at a mean follow-up of 5 years 1.
Treatment Overview
The treatment for lower gastrointestinal bleeding from internal hemorrhoids typically begins with conservative measures, but for persistent bleeding, medical procedures such as rubber band ligation are necessary.
- Increasing dietary fiber (25-30g daily) and maintaining adequate hydration can help soften stools and reduce straining.
- Sitz baths for 10-15 minutes, 2-3 times daily using warm water can provide relief and promote healing.
- Topical treatments including witch hazel pads or over-the-counter hemorrhoid creams containing hydrocortisone 1% can reduce inflammation and discomfort.
Medical Procedures
For persistent bleeding, the following medical procedures may be necessary:
- Rubber band ligation: the most common office procedure, with a success rate of 80% and 69% of patients being symptom-free at a mean follow-up of 5 years 1.
- Sclerotherapy: a less effective treatment compared to rubber band ligation, with a higher incidence of recurrence 1.
- Infrared coagulation: a treatment that focuses infrared radiation on the hemorrhoidal tissue, with a success rate of 67%-96% for first- or second-degree hemorrhoids 1.
- Surgical hemorrhoidectomy: the most effective treatment, but associated with significantly more pain and complications, and should only be recommended for a small minority of patients 1.
Indications for Hemorrhoidectomy
Indications for elective hemorrhoidectomy include:
- Failure of medical and nonoperative therapy
- Symptomatic third-degree, fourth-degree, or mixed internal and external hemorrhoids
- Symptomatic hemorrhoids in the presence of a concomitant anorectal condition that requires surgery
- Patient preference, after discussion of treatment options with the referring physician and surgeon 1.
From the Research
Treatment Options for Lower GI Bleeding Caused by Internal Hemorrhoids
- Medication and non-operative measures, such as rubber band ligation and injection sclerotherapy, are effective treatments for low-graded internal hemorrhoids 2
- Rubber band ligation is a commonly used treatment for first to third-degree internal hemorrhoids and can be performed using colonoscopy for enhanced visualization and maneuverability 3
- Other non-surgical treatments for internal hemorrhoids include infrared coagulation and injection sclerotherapy, which can be performed on an outpatient basis without anesthesia 4
Efficacy and Safety of Treatment Options
- Colonoscopic rubber band ligation has been shown to be safe and effective for the treatment of symptomatic grade II hemorrhoids, with high patient satisfaction and low complication rates 3
- Rubber band ligation has been found to be more efficient than other non-surgical treatments in reducing bleeding and prolapse, with similar short-term efficacy but better long-term results 4
- However, severe complications such as massive bleeding can occur after rubber band ligation, highlighting the need for strict follow-up and monitoring 5
Surgical Treatment Options
- Surgery is indicated for high-graded internal hemorrhoids or when non-operative approaches have failed, and may include excisional hemorrhoidectomy, stapled hemorrhoidopexy, or hemorrhoidal artery ligation 2, 6
- Excisional hemorrhoidectomy is a highly effective treatment for advanced hemorrhoids but can result in significant post-operative pain and prolonged recovery 6
- Minimally invasive procedures such as stapled hemorrhoidopexy and hemorrhoidal artery ligation may offer advantages in terms of reduced pain and faster recovery 2, 6