What is Sclerotherapy for Piles?

Piles, also called haemorrhoids, are swellings in or around the anal region. Piles are the most common (nearly 40 million Indians) anorectal disease affecting adults irrespective of their age and sex. Among the wide range of treatment options for managing piles, a non-surgical modality is a sclerotherapy. The first sclerotherapy procedure dates back to the year 1928, done by Dr Dixon in the United States. This procedure is used for internal haemorrhoids arising due to the abnormal enlargement of anal tissues. Chemicals called sclerosing agents or sclerotherapy agents are injected into the veins using a needle to shrink the haemorrhoids.^1-5

Symptoms

• Painless bleeding during defecation 
• Itching around the anal region
• Dampness and anal discomfort
• Prolapse or bulge out of the anal region

 You should seek medical consultation if you notice these symptoms without delay. Depending upon the degree of severity, your doctor will decide on the need for sclerotherapy.⁷ 

Diagnosis

Your doctor or proctologist will take a detailed history and thorough physical examination to confirm haemorrhoids. He may consider using a proctoscope, which is a short tube with a light on one end to view the tissues surrounding the anal region. If the diagnosis of internal haemorrhoids is confirmed, your physician may suggest the need for sclerotherapy.³

Your doctor will recommend a sclerotherapy procedure in the following situations: ⁷

• Symptomatic piles associated with bleeding.
• Bleeding disorder or high risk of bleeding.
• Immune-deficient states like AIDS

Treatment

Before sclerotherapy, you will be given anaesthesia to reduce the sensation of pain. As anaesthesia will induce a feeling of numbness, you should ensure some caretaker or someone from your family should accompany you. In this section, we will learn in brief about sclerotherapy

1. Before the surgery:
   • You should avoid taking any painkillers to reduce the risk of bleeding.⁹
   • Ask your doctor about any diet instructions to be followed. You might be given an enema injection to empty the bowel.⁹ 
2. Types of sclerotherapy:⁷
   • Endoscopic injection sclerotherapy (EIS) involves the use of an endoscope (a thin tube with a camera on one end) inserted two inches inside the anus to detect internal haemorrhoids and treat them.
   • Cap-assisted endoscopic sclerotherapy (CAES) is a recently discovered sclerotherapy. This new technique involves the use of a cap placed on the tip of a colonoscope and the use of a needle to control the direction and angle of injection.
   • Both types involve the use of liquid sclerosing agents. Additionally, the use of foam injections for performing sclerotherapy procedures is also increasing.⁸
3. Duration: treatment with sclerotherapy may be carried out two to four times or as recommended by the doctor to treat enlarged haemorrhoids. ³

In simple terms sclerotherapy helps in making piles a fibrous tissue which doesn’t bleed and eventually falls off. However pls consult your proctologist for best treatment.

Dr. M.G. Kartheeka, MBBS, MD

Read More: What is the Cost of Piles Surgery in India?

Points to be kept in mind after sclerotherapy: ⁷

• Avoid sitting for long periods and change your sedentary lifestyle. Include moderate-intensity exercises like walking into your daily routine. 
• With this procedure, infections are common, and thus there is a need for a proper antibiotic course. Ensure you take the prescribed medications as instructed. In case of any complaints post-sclerotherapy, contact your doctor.
• After sclerotherapy is completed, ensure your bowel remains soft. This can be done by increasing the intake of oral fluids (at least take six to eight glasses of water or any non-caffeinated drinks) and taking a high-fibre diet. Dietary sources of fibre include vegetables, fruits, beans, whole grains, figs, lentils, etc.⁸
• You should avoid straining after sclerotherapy. Avoid prolonged sitting and reading on the toilet seat. ⁶
• A sitz bath which involves soaking in warm water for ten minutes twice a day may help alleviate pain, anal itching, swelling, etc.⁶
• You should seek immediate care if you have a fever, abdominal pain, chills, urinary retention, or rectal bleeding after the procedure.⁸
• You can return to your work and normal activity after the procedure with the doctor’s permission.⁸
• Your bladder will empty faster in a squatting position in an Indian toilet. While using a Western toilet, place a stool under your feet and lean forward.⁸
• Avoid the use of cleansing wipes and soaps to clean the anal region, instead, wash with water. Avoid excessive washing of intimate regions.⁹ 

Surgery for piles is usually safe and secure. There might be some bleeding after the surgery due to swelling of tissues around anus which should gradually get better in a few days on its own.

Dr. Ashish Bajaj, M.B.B.S., M.D.

Read More: 8 Best Home Remedies For Piles

Complications

• Respiratory distress syndrome which occurs due to fluid build-up in the lungs, possibly due to the sclerosing agent. 
• Hepatitis (liver inflammation) is associated with symptoms like fever, dark-coloured urine and itchy skin. This was also due to the toxicity of the sclerosing agent used
• Abdominal compartment syndrome is characterised by abdominal distension.⁷

The following are the possible common side effects after sclerotherapy:

• Pain, ulcers, bleeding and inflammation at the injection site²
• Pus formation in the prostate gland² 

Sclerotherapy may increase the risk of the following conditions:

• Impotency
• Bacterial infection
• Thrombosed haemorrhoids  
• Recurrent haemorrhoids are, however rare.^2,3

Haemorrhoids sclerotherapy is contraindicated in the following conditions:⁷

• Thrombosed haemorrhoids
• Liver, kidney and heart-related diseases
• Inflammatory bowel disease
• Allergy-prone individuals

Also Read: Is Anal Sex Safe? A Comprehensive Guide to Risks and Safety Measures

Conclusion

Different treatment modalities, including non-surgical methods like sclerotherapy, have been used for decades for managing piles associated with bleeding or a high risk of bleeding. The sclerotherapy procedure involves injecting sclerosing agents into the veins surrounding the anal region or into the haemorrhoids. The benefits of this procedure should always be outweighed the associated risks, side effects and complications.  

Frequently Asked Questions:

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References:

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2. Margetis N. Pathophysiology of internal haemorrhoids. Annals of gastroenterology. 2019 Apr 27:264. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479658/
3. Enlarged haemorrhoids: What surgical procedures are used to treat haemorrhoids?  Institute for Quality and Efficiency in Health Care (IQWiG); 2017. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279465/
4. Chinnabhovi M. A study on clinical profile of patients with haemorrhoids attending tertiary care hospital. 09(02) 2022; 2515-8260. Available at: https://ejmcm.com/pdf_18980_2cf9de8e7de30fb8ddec4d4db2823970.html 
5. Ferrara F. Sclérothérapie: ma méthode. Angéiologie 2010; 62:78-82. Available at: https://www.pagepressjournals.org/index.php/vl/article/view/AncestCorner.2012.1/html
6. Wu X, Wen Q, Cui B, Liu Y, Zhong M, Yuan Y, Wu L, Zhang X, Hu Y, Lv M, Wu Q. Cap-assisted endoscopic sclerotherapy for internal haemorrhoids: technique protocol and study design for a multi-center randomized controlled trial. Therapeutic Advances in Gastrointestinal Endoscopy. 2020 Jun; 13:2631774520925636. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278306/
7. He A, Chen M. Sclerotherapy in haemorrhoids. Indian Journal of Surgery. 2022 Apr 20:1-5. Available at: https://link.springer.com/article/10.1007/s12262-022-03414-3
8. Goglia M, Nigro C, Aurello P, Diaco E, Trompetto M, Gallo G. Preliminary results of the first 50 patients undergoing sclerotherapy for II-degree haemorrhoidal disease using an automated device. Frontiers in Surgery. 2022; 9. Available at: https://www.frontiersin.org/articles/10.3389/fsurg.2022.882030/full
9. Villalba H, Abbas MA. Haemorrhoids: modern remedies for an ancient disease. The Permanente Journal. 2007; 11(2):74. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057743/