I think I have hemorrhoids. Can they be treated at the time of my colonoscopy?
Two treatments can be performed at Digestive Health or Mercy Regional Medical Center while you are sedated for colonoscopy:
Infrared coagulation (IRC)
IRC uses an infrared light source to heat (photocoagulate) pea-sized dots of skin in the rectum just above the hemorrhoid. Typically, 6-12 coagulations are performed in a session, moving around the circumference of the lower rectum. This treatment is painless when performed under sedation immediately following the completion of your colonoscopy. Recovery is usually immediate. A mild aching discomfort occasionally follows treatment for up to an hour. As the healing process begins to occur in the days following treatment some minor bleeding is typical, as the coagulated tissue begins to slough.
This treatment works in part because the healing process leads to beneficial scar tissue formation which "tacks" the loose hemorrhoidal tissues to the underlying rectal wall and reduces blood flow into the remaining hemorrhoidal channels. IRC rarely leads to significant complications. Multiple treatments are often necessary to achieve maximal benefit.
Band ligation
Higher grade hemorrhoids, particularly those which protrude, or prolapse through the anal canal, are not good candidates for treatment with IRC but often respond well to hemorrhoidal band ligation. This treatment can be performed at the completion of a colonoscopy. The doctor uses a device known as a ligator inside the rectum (above the border of sensitive anal canal skin) to suction the loose tissue at the base of the hemorrhoid into a small cup around which a tiny rubber band is placed, leaving a small firm ball of tissue about the size of a large blueberry. With conventional banding techniques (no longer commonly used at Digestive Health), up to three bands may be placed during a treatment session. While the performance of the banding itself is painless under sedation, it is not unusual for patients to awaken after conventional banding with an aching anorectal discomfort, . Usually this subsides over the course of an hour or so, but occasionally it will require treatment with sitzbaths and medication for a day or more. The healing process involves clot formation (thrombosis) in the affected hemorrhoid and sloughing of the banded tissue over the course of a week or so. While this is often a painless process, in some cases pain, protrusion of the thrombosed hemorrhoids and bleeding can be significant problems. Rare but potentially life-threatening infections have been reported after banding, so it is important to keep your doctor informed if you are having any persistent or worsening symptom such as pain, particularly in the presence of fever or chills, after this treatment. Band ligation may be safely repeated, and multiple treatment sessions are often needed to achieve maximal benefit.
In most cases at our facility conventional hemorrhoidal banding has been replaced by CRH O'Regan banding, a procedure we have found to be much better tolerated. CRH O'Regan banding (see below) is rarely associated with significant pain or serious complications.
If you are experiencing hemorrhoidal symptoms and want your gastroenterologist to consider performing one of these treatments please discuss this with us before your procedure.
Hemorrhoid Treatment Aftercare for infrared coagulation and conventional band ligation
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