It requires grounding time and provides excellent control of pain. Sclerotherapy works if banding is not possible or if bleeding is a problem. Drawbacks include greater incidence of a poor outcome, possibility of anaphylaxis, sepsis, and ulceration. Laser therapy, though expensive, provides no advantage over other methods. Operators must control the laser to avoid bleeding.
Anal stenosis is a possible complication.
Treatment of Grade IV internal hemorrhoids requires a surgical consultation. The goal of therapy is to reduce pain and constipation. These are used to avoid straining and constipation. Allows the incorporation of water and fat into the stool, causing the stool to soften. Topical Anesthetics - These agents are indicated for pain.