First off, it is important to ensure that the symptoms are not caused by another condition. For example, the presence of blood can be the result of an anal fissure, proctitis or a tumor. This is why it is so important to perform a differential diagnosis.
If hemorrhoids are identified as being the cause of the symptoms, the most appropriate treatment is then chosen. Very often, the creams and ointments offered on the market only provide temporary and partial relief. If this is the case, it is time to consult a doctor.
For over 25 years, other treatments have been preferred over surgical treatment in the vast majority of cases. Hemorrhoid surgery has a reputation for being very painful: indeed, patients often have to endure severe pain for anywhere from two to four weeks. Furthermore, surgery does not in any way prevent hemorrhoids from recurring.
Several other techniques have been attempted with a view to replacing surgery and only one has proven to be superior to all other methods: hemorrhoidal ligation.
The procedure consists of sucking the hemorrhoidal vein into a small cylinder, then ejecting two elastic bands at the base of the hemorrhoidal varicose veins. This results in strangulation of the vein.
When the technique is performed well, ligation is not painful. The patient experiences discomfort that usually lasts about twelve hours. He will also feel a false urge—in other words, the need to defecate—(even if the rectal ampulla is empty).
The exception is when patients have a concomitant anal fissure. In this case, the pain can be more severe, sometimes lasting up to a week. Patients are generally given analgesic medication or ointments in this particular situation.
After two to three days, the necrotic hemorrhoid and the rubber bands combine with feces.
A little blood can often be seen in the week following the ligation. This occurs when the hemorrhoid falls off.
After one or two weeks, a whitish scar will often appear at the ligation site.
In addition to eliminating the hemorrhoid, the ligation technique creates a small scar that keeps the mucous membrane in place and helps prevent new hemorrhoids from forming.
As most patients generally have two or three hemorrhoidal bundles, the treatment is done over two or three sessions.
In certain cases, more than one ligation can be done during the same visit. This does, however, result in greater discomfort.
When the decision is made to treat more than one, such as when two hemorrhoidal bundles are bleeding, you can expect more pain in the days that follow, but the pain remains moderate in most cases.
Exceptionally, up to six ligations or more can be done in one session, but this is quite rare.