Sclerotherapy (injection of piles)

Injection sclerotherapy is indicated for first degree haemorrhoids in which conservative management has failed, and for most second degree haemorrhoids. In this procedure, a small volume of an irritant solution is injected into the submucosa around the pedicles of the three major haemorrhoids.

There are two theories as to how it works:

• irritant solution causes a fibrotic reaction which obliterates the haemorrhoidal veins and leads to atrophy of the haemorrhoid
• precipitates local inflammation with retraction of the cushion by fibrosis; veins are relatively unaffected

Procedure: a proctoscope is inserted into the anal canal and the piles bulge over the proctoscope rim. 5% phenol-in-oil is injected into the submucosal layer just above the pectinate line. The injections should not be painful.

The patient may experience some discomfort for the first 2-3 days after the procedure. However, the discomfort usually resolves and the patient notes some benefit after 6-10 days. Treatment may need to be repeated, often up to three times with an interval of up to six weeks between injections.

One rare complication is a misplaced injection into the prostate (1); this is heralded by haematuria and fever. It usually settles without treatment.

It has the advantages of being cheap and easy to carry out in the outpatient setting. However, its effect is not as permanent as other treatment modalities.

Reference:

• BMJ (1997), 314, 1211-12.