Anoscopy is essential in evaluating painless hemorrhoids. Bleeding should cease at least temporarily. In certain circumstances, multiple hemorrhoids can be ligated at a single sitting. Infrared photocoagulation is useful for ablating small internal hemorrhoids, hemorrhoids that cannot be rubber band ligated because of pain sensitivity, or hemorrhoids that are not cured with rubber band ligation. Modalities of unproven efficacy include laser destruction and various types of electrodestruction.
Hemorrhoidectomy is performed infrequently for bleeding hemorrhoids.
Protruding internal hemorrhoids are treated by rubber band ligation. With mixed internal and external hemorrhoids, only the internal component should be rubber band ligated. If there is no significant internal component, hemorrhoidectomy is required. Infrequently, simple incision and evacuation of the clot may relieve pain rapidly. All rights reserved.