Laser in proctology: laser hemorrhoid treatment, anal fissure and skin tags

The laser used in proctology delivers a precise dose of energy to the tissue through the tip of a thin, flexible fiber. The energy heats the tissue, shrinks it and seals small blood vessels. With hemorrhoids, the energy is delivered inside the node: over the following weeks the node gradually shrinks, firm connective tissue forms in its place and the mucous membrane is anchored firmly in position.

In LHP, the laser is used not to cut tissue but to shrink it from the inside. That is why no large wound is left, and bleeding is usually minimal. But the laser is only a tool: the result is determined by the right diagnosis and the right choice of method.

Hemorrhoids: laser hemorrhoidoplasty (LHP)

LHP is the area where laser is most often used in proctology. A thin laser fiber is inserted into the node through a small puncture at the edge of the anus, and each node is treated separately. The mucous membrane and skin are not cut, and stitches are usually not placed. LHP is most suitable for stage II and III internal hemorrhoids when the nodes are not very large. About the stages and other methods: hemorrhoid treatment.

Laser treatment of a chronic anal fissure

An anal fissure (in everyday speech a “tear in the bowel”) is an elongated wound in the skin of the anal canal. An acute fissure often heals with diet, toilet habits and an ointment prescribed by a doctor. With a chronic fissure lasting more than 6–8 weeks, however, the edges of the wound harden and it does not close on its own. In such cases, the hardened edges and base of the fissure are treated with laser, which creates the conditions for healing.

One cause of a fissure is spasm of the sphincter (the ring-shaped muscle that closes the anal canal). The laser itself does not relieve the spasm. So if the spasm is strong, another method may be chosen alongside laser or instead of it, for example, sphincterotomy (cutting a small part of the internal sphincter). More: anal fissure treatment and the symptoms of an anal fissure.

Anal skin tags

Anal skin tags are soft, skin-colored folds of skin at the edge of the anus that usually cause no pain. They often remain after a past thrombosis, after hemorrhoids or after childbirth. They are not dangerous, but they can make hygiene harder, cause itching and irritation and be a cosmetic concern. Skin tags are removed with a small procedure, by laser or another method. If the diagnosis is in doubt, the removed tissue is sent for testing. We explain how a skin tag differs from a hemorrhoid node in the article What are hemorrhoids.

Laser is a modern and comfortable method, but it is not the right choice for every patient. Another method may suit better if:

• the hemorrhoids are stage IV and the nodes are always outside;
• in stage III the nodes are very large and have a big external part: such nodes need to be removed surgically;
• there is acute inflammation or a purulent process in the anal area: that is treated first;
• in a chronic fissure, the sphincter spasm is strong;
• the cause of bleeding is still unclear: the examination is completed first, and if needed a colonoscopy is done.

In such cases we offer hemorrhoidectomy with LigaSure (surgical removal of the nodes), the Longo (stapler) procedure or another method. When needed, we combine several methods in one session.

In a properly selected patient, the advantages of laser are these:

• the mucous membrane and skin are not cut, and no large open wound is left;
• pain after surgery is usually less than with methods that involve cutting;
• the operation is short: LHP usually takes 15–20 minutes;
• you are often discharged the same day or the next day;
• you return to daily life and desk work sooner.

These are average figures. The exact timeline is given after the examination.

This is one of the most common questions at consultations. The answer depends on the stage and size of the nodes:

Recovery after laser is more comfortable, while a cutting operation lowers the risk of recurrence more with large nodes. That is why the method chosen is not “the most modern one” but the one that suits your nodes.

• At your appointment you are examined: inspection of the area around the anus, a finger (digital rectal) examination and anoscopy.
• If there is bleeding, the rectum is also checked. For patients over 40 who have constipation, we recommend a colonoscopy before the operation.
• Before the operation you have blood tests, and you meet the anesthesiologist.
• If you take blood thinners (for example, aspirin or warfarin), be sure to tell us, and do not stop them on your own.
• On the day of the operation you may need to come fasting and to clean the bowel. You will be told in advance, separately, what you need to do.

1. Anesthesia. The type of anesthesia (spinal, general or local numbing) is chosen together with the anesthesiologist according to your health and the extent of the operation.
2. Inspection. The anal canal is examined again, and the nodes to be treated are confirmed.
3. Inserting the fiber. A thin laser fiber is inserted into the node through a puncture of one or two millimeters at the edge of the anus.
4. Laser energy. The energy is delivered into the node in a measured dose, and the node shrinks. Each node is treated separately.
5. Finishing. Stitches are usually not needed. LHP usually takes 15–20 minutes; if an anal fissure is also treated or a skin tag is removed in the same session, it takes longer.
6. Observation. You stay under observation for a few hours. You are often discharged the same day or the next day.

With an anal fissure and skin tags the process is similar: after anesthesia, only the problem area is treated with laser.

During the operation, pain is eliminated with anesthesia. In the following days there may be mild burning, a feeling of tension and swelling. These sensations are usually strongest in the first days and gradually ease. Pain is kept under control with the painkillers your doctor prescribes.

The most common question is about the first bowel movement. Your diet is planned in advance so that the stool is soft, and if needed a stool softener is prescribed. The first bowel movement may burn a little, but the sensation is passing.

Like any surgical procedure, laser has risks. They are usually low, and most are temporary:

• swelling and burning that last a few days;
• a small amount of bleeding during a bowel movement;
• a clot forming in a treated node (thrombosis);
• temporary difficulty passing urine after anesthesia;
• rarely, infection.

With large nodes, the chance of hemorrhoids forming again after laser may be higher than after the nodes are cut out. That is why proper patient selection and preventing constipation after the operation are important.

• First day: a few hours later you can walk, eat and drink, and pain is kept under control with medication.
• First week: high-fiber food, enough water (about 1.5–2 liters a day unless your doctor says otherwise) and no straining; if your doctor recommends it, a warm sitz bath after a bowel movement. You can often return to desk work after a few days.
• 2–4 weeks: the nodes gradually shrink and the swelling goes down. You return to exercise and heavy lifting with your doctor's permission.
• Follow-up visit: usually after a week.

If you have fever, bleeding that does not stop, cannot pass urine or the pain keeps increasing, don't wait; call right away. The exact timeline is given after the examination.