From the Guidelines
Rubber band ligation is the most effective and recommended treatment for grade 2 hemorrhoids, with a higher rate of efficacy and fewer additional therapies required compared to other nonoperative treatments like sclerotherapy and infrared photocoagulation 1.
Treatment Options
When considering treatment for grade 2 hemorrhoids, it's essential to weigh the effectiveness, potential complications, and patient preferences. The American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids provides valuable insights into the various treatment options available 1.
- Conservative measures such as increasing fiber intake, drinking plenty of water, and using over-the-counter medications can be the initial approach.
- Topical treatments like hydrocortisone cream and over-the-counter pain relievers can help manage symptoms.
- Office-based procedures like rubber band ligation, sclerotherapy, or infrared coagulation are considered when conservative measures fail.
Nonoperative Techniques
Nonoperative techniques are generally preferred over surgical interventions due to lower risks of pain and complications 1.
- Rubber band ligation has been shown to be more effective than sclerotherapy, with fewer additional treatments required 1.
- Infrared photocoagulation is another option, with a success rate of 67%-96% in controlling hemorrhoidal bleeding for first- or second-degree hemorrhoids 1.
Surgical Intervention
Surgical intervention, such as hemorrhoidectomy, is typically reserved for cases where nonoperative treatments have failed or are not suitable, and is associated with significantly more pain and complications 1.
- Indications for elective hemorrhoidectomy include failure of medical and nonoperative therapy, symptomatic third-degree or fourth-degree hemorrhoids, and patient preference after discussion of treatment options 1.
From the Research
Treatment Options for Hemorrhoid Grade 2
- Conservative treatment is recommended as the basic treatment for symptomatic hemorrhoids, regardless of grading 2
- The vast majority of grade II haemorrhoids are treated conservatively 2
- Surgery may be considered in a few cases with pronounced symptoms, with options including:
- Chirurgia minor
- Doppler guided dearterilization procedures
- Stapled haemorrhoidopexy 2
- Medical management, such as stool softeners, topical over-the-counter preparations, and topical nitroglycerine, is a mainstay of initial therapy 3
- Dietary modifications, such as increased fiber and water intake, and behavioral therapies, such as sitz baths, are also recommended 3
- Office-based treatment with rubber band ligation is a preferred next step if initial therapy is unsuccessful, due to its lower failure rate compared to infrared photocoagulation 3
- Hemorrhoidal artery ligation may be a useful option for grade II hemorrhoids, as it may result in less pain and quicker recovery 3