Emerging treatments
Electrotherapy
Electrotherapy (also known as electrocoagulation) is an alternative to banding for patients with grade 1 or 2 hemorrhoids, and an alternative to surgery for patients with grade 3 or 4 hemorrhoids.[32] Approaches include a low-amplitude direct electric current (between 8-16 mA) used in the office setting, or a higher amplitude direct electric current (up to 30 mA) with the patient under general or spinal anesthesia. In the UK, the National Institute for Health and Care Excellence (NICE) recommends electrotherapy for the treatment of grade 1 to 3 hemorrhoids in adults.[32]
Phlebotonics
Phlebotonics are a diverse group of drugs that include natural flavonoids from plant extracts and synthetic compounds such as calcium dobesilate. Phlebotonics may be helpful for treatment of both acute and chronic hemorrhoidal disease.[13] Their mechanism of action is not fully established, but they are thought to strengthen blood vessel walls, increase venous tone, increase lymphatic drainage, and normalize capillary permeability.[13] In one Cochrane review, phlebotonics significantly reduced pruritus, bleeding, discharge, leakage, and overall symptoms in patients with hemorrhoids, but heterogeneity was significant and there were methodologic limitations in many of the included trials.[33]
Radiofrequency ablation
Radiofrequency ablation of hemorrhoids (Rafaelo procedure) has gained popularity both as an outpatient and inpatient procedure for grade 1 to 3 hemorrhoids. A specially designed probe connected to a radiofrequency generator is inserted into hemorrhoidal cushions causing the tissue to heat up, and hemorrhoids to become necrotic and shrink. Short-term outcomes of this procedure are promising, but medium- to long-term outcomes are still largely unknown.[34]
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