Treatment methods

Individual treatment, depending on the stage of the haemorrhoids

The proctologists at Schoen Clinic work according to the latest scientific standards and treat your haemorrhoidal condition after a detailed diagnosis, always according to the stage and depending on your symptoms. However, the symptoms do not necessarily have to fit the stage of the haemorrhoids. Depending on the severity of the disease, different therapy options can be considered. 

Conservative treatment methods

Haemorrhoids: Treatment without surgery

In stage I, a change in your eating habits and increased exercise in everyday life are usually sufficient. A soft, shaped bowel movement should be achieved by sufficient fluid intake and a diet rich in fibre. In the case of slightly enlarged haemorrhoids, the intake of household remedies such as psyllium seeds and, if necessary, light laxatives can have a supporting effect. Please discuss the use of laxatives with your treating physician. Creams containing either cortisone or local anaesthetics may help alleviate symptoms such as itching, burning or oozing. These soothing drugs do not offer a cure.
The measures mentioned are also the basis for the treatment of haemorrhoids in higher stages.
If the symptoms should not improve clearly with the use of drugs and ointments, the haemorrhoids can also be injected. A sclerosing substance is injected into the blood supply and the haemorrhoids shrink within a few weeks. This sclerotherapy is performed on an outpatient basis, is almost painless and takes only a few seconds. The injection can be repeated if necessary and usually helps over a longer period of time. This differs on an individual basis – sometimes the treatment helps for several weeks, sometimes years.
The injection of haemorrhoids is also the first treatment for haemorrhoids in stage II.
Alternatively, rubber band ligation can be performed, in which a rubber ring is placed around the haemorrhoids. The haemorrhoid dies off due to a lack of blood circulation and comes away after one to two weeks. This can occasionally lead to heavy bleeding. In this case, you should consult your treating physician.

Surgical treatment methods

Haemorrhoid surgery

If the conservative treatment options do not lead to a significant improvement in the symptoms and haemorrhoid size or if you have haemorrhoids in stage III, we consider performing an operation. There are several possibilities. Our specialists will discuss individually with you which of these options is the right one for you.

Classic Milligan-Morgan or Ferguson surgery

In classic Milligan-Morgan or Ferguson surgery, the haemorrhoids are removed with a scalpel or electric knife. Using the Ferguson method, the wound in the anal mucosa is closed with a suture; with the Milligan-Morgan method, the wound remains open. The wounds are then injected with a local anaesthetic and a block anaesthetic is applied (called pudendal block). This relieves the pain for six to twelve hours. If necessary, you will receive further painkillers afterwards. These procedures are used for haemorrhoids that occur in one or two places.

Haemorrhoidal artery ligation (HAL)

In haemorrhoidal artery ligation (HAL) from Japan, the supplying vessel of the haemorrhoid is identified with an ultrasound device in a proctoscope and subsequently sutured. This shrinks the haemorrhoids and reduces the risk of bleeding. If the haemorrhoids are voluminous and therefore have a significant blood supply, they can be additionally obliterated using laser probes (laser haemorrhoidoplasty).
If there is also a prolapse of the anal mucosa, we will suture the mucosa again. The physician calls this recto-anal repair (HAL-RAR). This surgical method may also be suitable for haemorrhoids in stage I that continue to cause discomfort despite conservative therapy.

Stapled hemorrhoidopexy

In stapled hemorrhoidopexy (also called the Longo procedure), the haemorrhoids themselves remain untouched. A stapler is used to remove a ring from the mucous membrane immediately above the haemorrhoids. As a result, the haemorrhoids are pulled upwards and less blood is supplied to them – they shrink. This procedure is usually perceived to be less painful, it is particularly suitable for haemorrhoids in several places (symmetrical occurrence).

Haemorrhoids in stage IV are initially returned to stage III using swelling-reducing measures such as local cooling or swelling-reducing drops. This results in better surgical conditions for you with less discomfort.