Sclerotherapy works if banding is not possible or if bleeding is a problem. Drawbacks include greater incidence of a poor outcome and the possibility of anaphylaxis, sepsis, and ulceration. Laser therapy, though expensive, provides no advantage over other methods. Operators must control the laser to avoid bleeding. Rectal wall prolapse Large anorectal fissure or infection Tumor Hemorrhoidectomy is the treatment for severe grade III, IV, or strangulated hemorrhoids.
Anal stenosis is a possible complication.
Treatment of grade IV internal hemorrhoids requires a surgical consultation. The goals of therapy are to reduce pain and constipation. These are used to avoid straining and constipation. Allows incorporation of water and fat into stool, causing stool to soften. Topical Anesthetics - These agents are indicated for pain.