ROSH Gastrointestinal Practice Exam

What is the most effective management option for a patient experiencing severe rectal pain and bleeding due to chronic internal hemorrhoids?

1. Bipolar cautery

2. Hemorrhoidectomy

3. Injection sclerotherapy

4. Rubber band ligation

The correct answer is: Injection sclerotherapy

Among the management options available for chronic internal hemorrhoids, injection sclerotherapy is a minimally invasive procedure that is often effective. It involves the injection of a sclerosant solution into the tissues surrounding the hemorrhoid, which helps to reduce blood flow to the hemorrhoid, causing it to shrink and eventually resolve. This procedure is particularly suitable for patients experiencing severe rectal pain and bleeding because it is less invasive compared to surgical options like hemorrhoidectomy, which involves the surgical removal of hemorrhoids and generally entails more significant recovery time and potential complications. Injection sclerotherapy can often be performed in an outpatient setting and does not usually require anesthesia, making it a more palatable option for many patients suffering from chronic symptoms. Additionally, injection sclerotherapy is associated with a lower rate of complications than surgical interventions and can provide effective symptom relief, making it a particularly useful choice for managing patients with chronic issues like hemorrhoids. While other options such as rubber band ligation can also be effective, they may not be as suitable for cases with severe symptoms or larger hemorrhoids. Rubber band ligation typically works best for smaller internal hemorrhoids, and the procedure might not provide the necessary relief for patients with more significant pain or bleeding. In summary, injection s