Haemorrhoid Injections (Sclerotherapy): Cost, Results and Who It Suits
Why People Search for Haemorrhoid Injections
The phrase that brings most people to this page is some version of "can they just inject them?" It is a reasonable hope. The alternatives people have already read about sound worse — a band clamped onto the tissue, a radiofrequency probe, an operation with a recovery measured in weeks. An injection sounds like the version of this that happens in ten minutes and lets you go back to work. In large part that is accurate: injection sclerotherapy is genuinely quick, genuinely does not require an anaesthetic, and for the right haemorrhoid it genuinely stops the bleeding. What the clinic brochures tend to leave vague is which haemorrhoid is the right one, how long the effect lasts, and how it performs when it is put side by side with the cheaper and more widely used option. This article sets all of that out, including the published trial evidence rather than the marketing. We should say plainly at the start that our clinic does not offer sclerotherapy — we provide eXroid electrotherapy and nothing else — so what follows is a description of a treatment you would need to arrange through your GP or another private provider, and you should weigh it with that in mind.
What Sclerotherapy Actually Is
Sclerotherapy means injecting a chemical irritant — a sclerosant — into the tissue at the base of an internal haemorrhoid, using a fine angled needle passed through a proctoscope. The needle does not go into the haemorrhoid itself in the way most people picture. It goes into the loose submucosal layer above it, at the top of the anal canal, above the dentate line where the sensory nerve endings that would make this painful are sparse. The sclerosant then does two things. It damages the wall of the small feeding vessels so that they thrombose and close, which is what stops the bleeding. And it provokes a controlled inflammatory reaction that scars down over the following weeks, tethering the slipped cushion back against the muscle wall beneath it. That second effect is the one that matters for anyone whose haemorrhoids have started to come down, because the underlying problem in this condition is not really swelling — it is that the anchoring tissue holding the anal cushions in place has stretched and given way. Sclerotherapy is an old treatment, in continuous use since the late nineteenth century, and its persistence in colorectal clinics more than a century and a half later says something about how cheap, quick and low-risk it is rather than about how powerful it is.
What Gets Injected: Phenol, Polidocanol and Foam
The agent varies by country and by clinic, and it is worth asking which one you are being offered. The traditional UK sclerosant, and still the one most NHS colorectal clinics use, is 5% phenol in almond oil — typically two to three millilitres per haemorrhoid, up to three haemorrhoids in a sitting. It is inexpensive, familiar and effective at stopping bleeding. The more recent shift, driven largely by practice in continental Europe and Asia, has been towards polidocanol, either as a liquid or whipped into a foam with air or carbon dioxide. Foam has the advantage that a small volume of drug spreads over a larger surface of vessel wall, so less agent does more work. Randomised comparisons of the two have generally favoured polidocanol on session count and patient satisfaction, and one such trial reported an overall complication rate of around 3.6%, with mucosal ulceration the only complication seen and all of those cases occurring in the phenol arm. That is a single trial and should not be over-read, but the direction of travel in the literature is reasonably consistent. If you have a nut allergy, the almond oil carrier is a specific thing to raise before anyone injects anything, and it is the sort of detail that is easy to forget to mention in a consultation you are already embarrassed to be attending.
What the Appointment Is Like
Practically, this is an outpatient procedure with no preparation. There is no fasting, no bowel prep and no enema. You lie on your left side with your knees drawn up, the clinician performs an examination and a proctoscopy to see what is actually there, and if the findings fit, the injections follow immediately in the same position. The injecting part takes a couple of minutes. Most people describe a sensation of pressure or fullness rather than pain, for the anatomical reason given above, though a needle placed slightly too low — below the dentate line — produces an immediate sharp pain and is the signal for the clinician to reposition. Afterwards you get dressed and leave. A dull ache or a feeling of needing to open your bowels is common for a day or two, some spotting of blood is common, and most people are back to normal activity the same day. If you want a fuller account of the examination itself, which is the part people dread more than the treatment, we have written separately about what happens at a haemorrhoid appointment, and it applies to any anorectal clinic rather than only to ours.
Who It Works For, and Who It Does Not
This is where the honest answer narrows considerably. Injection sclerotherapy is at its best in grade 1 and smaller grade 2 internal haemorrhoids where bleeding is the dominant symptom — the classic picture of bright red blood on the paper or in the pan with no lump and no pain. In that group it is quick, cheap and effective. It performs much less well once prolapse is established. If your haemorrhoids come down and have to be pushed back, or stay down, you have grade 3 haemorrhoids or worse, and the volume of scarring a few millilitres of sclerosant can generate is not enough to hold that much descended tissue back where it belongs. Most colorectal services will steer grade 3 and 4 towards something with more mechanical effect. It does nothing at all for external haemorrhoids, which arise below the dentate line from a different vascular territory and cannot be injected safely, and nothing for skin tags, fissures or anything else that is causing pain rather than bleeding. If you are unsure which of these describes you — and most people genuinely are, because grade 3 internal haemorrhoids that prolapse are routinely mistaken for external ones — our severity test runs through the same questions a clinician would ask and takes a couple of minutes.
How Well It Works, According to the Evidence
Published success rates for sclerotherapy are wide, which is itself informative: they range from around 70% to over 90% for control of bleeding in low-grade disease in the short term, and the spread mostly reflects differences in grade mix, agent and how long the authors waited before counting. Short-term symptom control is not the contested part. Durability is. Symptom recurrence within one to four years is common enough that repeat courses are an expected part of the treatment rather than a sign that something went wrong, and a systematic review pooling office-based procedures found recurrence at three months broadly comparable between sclerotherapy and banding — in the region of 15% versus 10% — with the gap widening once follow-up extended beyond a year. A 2026 meta-analysis of eleven studies and 2,235 patients put the recurrence risk ratio at 1.51 in favour of banding, while noting the finding lacked robustness and needed cautious interpretation. The practical translation is straightforward. If what you want is to stop bleeding now with the least possible disruption, sclerotherapy delivers that reliably. If what you want is a single intervention that you never have to think about again, the evidence does not support expecting that from an injection, and anyone promising it is going beyond what has been published.
Sclerotherapy Versus Banding: The Comparison Most People Want
These two are the standard outpatient options in the UK and they get compared constantly, so it is worth being precise about where each one wins. On raw effectiveness they are closer than most people expect: the same 2026 meta-analysis found no significant difference in treatment success or patient satisfaction between them. Where they diverge is in two directions that pull against each other. Sclerotherapy is markedly more comfortable — that analysis found moderate-to-severe post-procedure pain roughly five times less common with injection than with rubber band ligation, and pain after banding is a real phenomenon rather than a rare complication, since a band placed slightly too low is exquisitely uncomfortable for days. Banding, in exchange, holds better over time and handles bigger haemorrhoids, which is why UK commissioning guidance from the Royal College of Surgeons and the ACPGBI has described banding as the best available outpatient treatment, with injection sclerotherapy positioned as an alternative for grade 1 disease or where banding is not suitable. Neither of those sentences is a verdict on your case. A person with grade 1 bleeding who cannot face discomfort and a person with bulky grade 2 disease who wants one intervention to last are correctly advised differently, and if you want the wider field set out, we have compared the non-surgical haemorrhoid treatments including infrared coagulation and the Rafaelo procedure elsewhere.
The Situation Where Injections Are Often Preferred: Blood Thinners
There is one group for whom sclerotherapy is frequently the first choice rather than the fallback, and it is worth knowing about because it comes up often and is poorly explained. Banding works by strangling a piece of tissue until it dies and detaches, usually somewhere between days three and ten, and when it detaches it leaves a raw ulcer at the base. In anyone taking anticoagulants or antiplatelet drugs, that delayed separation carries a genuine risk of secondary bleeding that can be brisk enough to need admission. Sclerotherapy has no detachment phase — nothing is cut off and nothing falls away — so the bleeding profile is different, and it has been studied specifically as an option in anticoagulated patients, with reassuring results reported in the Annals of the Royal College of Surgeons of England. If you are on warfarin, apixaban, rivaroxaban or clopidogrel and you have been told banding is not advisable, an injection may well be the thing you are offered instead, and asking about it directly is reasonable. The wider question of what treatment is possible on blood thinners is one we have written about separately, because it affects almost every option in this field and the answers differ more than you would expect.
Risks and Side Effects, Including the Rare Ones
For most people the entire list of what happens afterwards is: a dull ache for a day or two, a feeling of fullness or of needing to open the bowels, and a little spotting. Mucosal ulceration at the injection site is the commonest true complication and usually settles on its own. Beyond that the literature documents a short list of rare but serious events which any honest consent conversation should mention, because they are the reason the injection has to go in the right place: prostatic or retroperitoneal abscess, transient bacteraemia, tissue necrosis, urinary retention, and — reported in men after injection too far anteriorly — erectile dysfunction. These are genuinely rare, they are case-report rare rather than percentage rare, and none of them should stop a reasonable person having the treatment. But you are entitled to hear them before you consent rather than afterwards, and a clinic that describes the procedure as entirely without risk has told you something about the clinic rather than about the procedure. Ask who is doing the injecting and how many they do. This is a technique-dependent treatment and the serious complications cluster around misplaced needles.
What It Costs in the UK, and Whether the NHS Offers It
Sclerotherapy is available on the NHS, at no cost to you, in colorectal outpatient clinics across the country — though not every unit still offers it, since many have standardised on banding, and the route in is a GP referral followed by whatever the local waiting time happens to be. Privately, published prices as at September 2026 put a single injection session in the region of £300 to £750 depending on the clinic and the city, with the initial consultation typically charged separately at £250 to £300 and a proctoscopy sometimes billed on top again. London clinics sit at the upper end of that band; one Harley Street provider lists injections at £750 with a £295 consultation and a £175 proctoscopy, and prices the same clinic's banding at £750 and its radiofrequency ablation at £2,295. Two things are worth doing before you commit anywhere. Ask whether the quoted figure covers one session or a course, because multiple sessions are normal and a per-session price is not a per-treatment price. And ask what happens if the first session does not settle the bleeding. Our fuller breakdown of haemorrhoid treatment cost across the UK market covers the same ground for every other option, and the pattern it shows is that headline prices and total prices are frequently not the same number.
How Many Sessions, and What Happens When It Stops Working
Repeat injection at intervals of a few weeks is the normal pattern rather than the exception, particularly where more than one haemorrhoid is involved, and a course of two or three sessions is unremarkable. There is a practical ceiling to this, though, and it is not usually made explicit. Each round of sclerosant leaves fibrous scar tissue behind, and after several courses in the same place the submucosal plane becomes progressively harder to inject accurately and the tissue less responsive. Clinicians therefore tend to have a limit in mind, and if bleeding keeps returning after two or three courses the correct conclusion is usually that the mechanical problem has outgrown the treatment rather than that more of it is needed. That is the point at which to have the grading conversation again honestly, because piles that keep coming back after successful injections are often piles that have quietly progressed a grade. Options at that stage typically include banding, radiofrequency treatment, electrotherapy, or — for genuinely advanced disease — haemorrhoid surgery, and the sequence matters less than being assessed properly rather than repeating the last thing that half worked. The underlying habits matter too: none of these treatments does much for long if the straining that produced the problem continues, and a high fibre diet is doing quiet work in the background of every good outcome in this field.
When Bleeding Needs Investigating Rather Than Treating
One caution applies to injections exactly as it applies to every other treatment here. Bright red bleeding on wiping, in someone with a visible internal haemorrhoid on proctoscopy, is very likely coming from that haemorrhoid. But rectal bleeding has other causes, and treating a pile you can see is not the same as excluding something you have not looked for. Blood mixed through the stool rather than on its surface, a change in bowel habit lasting more than three weeks, unexplained weight loss, abdominal pain or a new onset over the age of fifty are all features that warrant investigation for bowel cancer before anyone injects anything. The overwhelming majority of people with those features turn out to have something benign; the point is the order of operations. A clinic that examines you, finds haemorrhoids, and proceeds to treat without pausing over a history like that has skipped a step. Ours writes to your GP the same day when an examination raises a concern, and we would expect any reputable provider to do the same.
What We Offer Instead, and Being Straight About It
We do not provide injections, so you are not being steered here. What we provide is eXroid electrotherapy, which shares sclerotherapy's general approach — treat the base of the haemorrhoid above the dentate line, close the feeding vessel, let the tissue shrink over the following weeks — but achieves it with a low-dose direct current applied through a probe rather than with a chemical. There is no cutting, no stitching and no general anaesthetic, up to three haemorrhoids can be treated in one session, and improvement is usually evident within seven to ten days and can continue for up to four weeks. On how many sessions people need: of 116 patients treated at our clinics since January 2025, 98 — that is 84% — needed only one treatment session, 17 needed two and one needed three. That is a record of what has happened, audited in September 2026, not a prediction about you; the number cannot be judged from an examination, so we do not promise a figure in advance. We should also be candid about the part that gets undersold: eXroid is uncomfortable, and a fair number of patients describe it as properly painful while it is happening, in the region of six or seven out of ten. It is short, it settles within about ten minutes of finishing, the current can be turned down at any point, and almost everyone tells us afterwards it was worth it against years of symptoms — but being told to expect mild discomfort and then experiencing that is a poor way to be treated. Sclerotherapy, for what it is worth, is the more comfortable procedure of the two. We are not going to pretend otherwise, and we have not seen a head-to-head trial of the two techniques that would let anyone claim more than that.
Where to Start
If bleeding is your main symptom, your haemorrhoids do not come down, and you would rather start with the least invasive thing available, asking your GP about injection sclerotherapy on the NHS is a sensible first move and costs you nothing but the wait. If they come down, if they have already been injected or banded without lasting benefit, or if the waiting list is longer than you can live with, the question becomes which mechanical option fits your grade, and that cannot be answered from a website — it needs someone looking. You can take our severity test to get a sense of where you sit, read what our procedure involves in full before committing to anything, book an appointment at our Glasgow or London clinic, or simply contact us with a question first. We are happy to answer one, including if the answer turns out to be that a treatment we do not offer is the better fit for you.
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