For patients with grade I or grade II piles or who have larger piles but wish to avoid surgical treatment, outpatient procedures, such as sclerotherapy, Laser (IRC), band ligation, and cryotherapy, may be appropriate. It gives very good results with no side effects. These procedures are painless. Do not need more then 30 minutes in the clinic. These procedures are called office treatment in the western world, meaning you come from your office during the break, get the treatment done and go back to your office.
1. Laser (The infrared coagulator /photocoagulation) is for outpatient treatment of internal first and second degree piles. A special bulb provides high intensity infrared light that coagulates vessels and tethers the lining to subcutaneous tissues. it is the most effective non surgical treatment modality.
2. Injection Sclerotherapy is usually indicated in first and second degree lesions. it gives good results. it can be also done in patient with advance diseases.
3. The least expensive and possibly the most widely used equipment is a rubber band ligator. This is suitable for first to third degree piles. Rubber band treatment works effectively on internal piles that protrude during defecation. The procedure sometimes produces mild discomfort and bleeding, but it is generally the treatment of choice for patients who have piles and for whom piles surgery is considered too radical, or when the patient specifically wishes to avoid surgical excision.
4. Cryotherapy is little used because of the profuse and prolonged discharge, the complications such as excessive sloughing and muscle injury that occur occasionally.
5. Hemorrhoidal Arterial Ligation (H.A.L.) is performed using a modified proctoscope in conjunction with a Doppler ultrasound flowmeter.