In this procedure, a sclerosing agent is injected into the hemorrhoidal nodule, which reduces the volume of the nodule through a local inflammatory reaction. This causes the congestion to subside.
This treatment is painless. The puncture is made directly into the inner hemorrhoidal cushion visible in the proctoscope. As the mucous membrane above the haemorrhoidal cushion does not feel any pain, the puncture is not noticed. So then a few microliters of Polidocanol are injected directly into the cushion. This briefly enlarges the knot, which can cause a slightly unpleasant pressing sensation, similar to a violent urge to defecate. This feeling disappears within seconds.
No special preparation, e.g. with enemas, is necessary. The normal toilet visit before the treatment is sufficient.
Once the proctoscope has been inserted, the whole treatment takes only about 30 seconds and is carried out on an outpatient basis without anaesthesia.
During the first bowel movement after the treatment, blood may be deposited. There are no restrictions on physical activities.
The advantage of the simple and painless procedure has the disadvantage that in 70% of cases the symptoms return within a year.
I have not yet triggered any allergies with polidocanol. Since it is an alcohol, it should not be used by dry alcoholics. Although the small amounts used are probably a theoretical risk. There are also no studies on tolerance during pregnancy, so that this method should better not be used in pregnant women. I consider the risk to be acceptable during breastfeeding, as the amount of alcohol that could enter the bloodstream under unfavourable circumstances is diluted by the mother’s blood to below the limit of detectability.
There is nothing to prevent the use in patients taking blood thinners (ASS, Marcumar, Falithrom or others). Bleeding haemorrhoids can even be treated particularly effectively by sclerotherapy in these patients.