- Equipment
- Anoscope
- 5 mL syringe
- 21G or 23G long injection needle (~4 cm)
- Sclerosant solution:
- Commonly 5% phenol in almond oil or sodium tetradecyl sulfate (STS)
- Swabs and lubricant
- Technique
- Insert Eisenhammer retractor
- Lubricate and gently insert anoscope into the anal canal
- Identify the haemorrhoid, usually at typical positions: 3, 7, and 11 o’clock
- Inject Sclerosant
- Insert needle just above the dentate line (to avoid pain — somatic nerves lie below it)
- Advance needle into the submucosa at the base of the haemorrhoid
- Inject 1–2 mL of sclerosant slowly into each haemorrhoid
- Withdraw needle gently and ensure no immediate bleeding
- Repeat
- Typically inject up to 3 haemorrhoids per session
- Avoid injecting too deep (risk of necrosis) or too superficial (ineffective)
- Post-Procedure Care
- No specific recovery time required — outpatient procedure
- Mild discomfort or urgency may occur briefly
- Advise high-fibre diet, hydration, and stool softeners
- Avoid straining or heavy lifting for a few days
- Complications
- Local discomfort, urgency, or minor bleeding
- Ulceration or mucosal sloughing (if injected too superficially or too much)
- Rare but serious: prostatitis, abscess, rectovaginal fistula (very uncommon with proper technique)