Injection Sclerotherapy and a Bulk Laxative in the Treatment of Bleeding Grade 1 Hemorrhoids

Abstract

Sixty-seven patients with bleeding Grade 1 hemorrhoids were allocated alternately to receive either injection sclerotherapy or a bulk laxative. In either treatment group one third of patients was constipated with passing hard stools.At 2 weeks, 4 weeks and half a year information on the outcome was obtained from diaries kept by the patients. Injection sclerotherapy proved to be clearly superior than the use of bulk laxative. 36%, 23% and 35% compared to 59%, 58% and 72%, respectively, continued to bleed. An unexpected finding was noted among the constipated. Statistical significance could not be obtained, but the use of bulk laxative may show perhaps even better results than injection sclerotherapy. At 4 weeks and after half a year, the rates were 33% and 36% compared to 50% and 60%, respectively. Among the non-constipated patients injection sclerotherapy is the treatment of choice.At 4 weeks and half a year, only 10% and 24% were still bleeding.When a bulk laxative was taken, the effect was negligibly small. 74% and 94%, respectively, showed no response. Recurrences were fewer after injection sclerotherapy. 21% of patients free of bleeding at 4 weeks became symptomatic again in the following 5 months compared to 54% of such patients using bulk laxative. Again, bulk laxative was of little use in patients without the complaint of constipation, but was as effective as injection sclerotherapy among the constipated. These results are in line with prior histological investigations detailing the value of injection sclerotherapy. However, they are in contrast to a report showing that injection sclerotherapy plus bulk laxative is not more effective than the use of bulk laxative alone. They are also different from a meta-analyis of 18 randomized, controlled clinical trials recommending rubber band ligation as the initial treatment of Grade 1 to 3 hemorrhoids. In addition to showing the place of injection sclerotherapy and bulk laxative in the treatment of Grade 1 lesions, the results of the present investigation emphasize the need to ensure comparability between studies by using similar treatment groups and to monitor bowel habits.

Effectiveness of sclerotherapy in the treatment of haemorrhoids

“…Sclerotherapy of haemorrhoids is a safe procedure, and a specially designed anoscope prevents such complications as: prostatitis, local necrosis at the site of injection, or stricture of the anus. The fact that there are many alternative methods for the treatment of haemorrhoids suggests that all of them are imperfect [3][4][5][6]. An ideal method should be both effective and low-invasive.…”

“…With this method usually stage 1 and 2 haemorrhoids are managed, and selected patients presenting with stage 3 can also be included. The method is simple and does not require anaesthesia [3,4]. Photocoagulation of the haemorrhoids utilises coagulator emitting infrared light that is applied in the area of haemorrhoidal bundle.…”

Hämorrhoidalleiden

“…Der Stuhl soll weich geformt sein und ohne Pressen entleert werden. Mit einer ballaststoffreichen Kost können die auf Hämorrhoiden zurückzuführen- den Blutungen ebenso günstig beeinflusst werden wie durch eine Sklerosierungsbehandlung, insbesondere bei obstipierten Patienten [7,20].…”

Langzeitergebnisse nach Staplerhämorrhoidopexie

“…kann bei bis zu 50% der Betroffenen eine Besserung erzielen [1,18]. Durch eine Sklerosierungsbehandlung kann die Effektivität gesteigert werden [5]. Die Sklerosierung erstgradiger Hämorrhoiden hat eine initiale Erfolgsrate von 70%-80%, jedoch nach 3 Jahren auch eine hohe Rezidivrate von bis zu 70% [18].…”

“…Acht weitere Patienten waren in der Zwischenzeit aus anderer Ursache verstorben, die übrigen 25 Patienten unbekannt verzogen. Das mittlere Follow-up betrug somit 6,2 ± 1,2 (4,(2)(3)(4)(5)(6)(7)(8)8) Jahre. Der Fragebogen beinhaltete Fragen zur Zufriedenheit, aktuellen Beschwerdesymptomatik, Stuhlkontinenz, zu Stuhlentleerungsstörungen und erneuten Therapiemaßnahmen sowie Fragen im Hinblick auf eine retrospektive Beurteilung der Schmerzhaftigkeit der Maßnahme.…”