Hemorrhoid treatment evidence in Montreal, honestly
This is the page the rest of the site points at when it declines to quote a figure. It sets out what the published sources actually agree on, and the four specific places where they do not agree at all.
Rather more is agreed than the disagreements suggest. Internal hemorrhoids are graded one to four. Office procedures are used for grades one to three that have not responded to conservative care. Banding is described as well suited to grade two. Surgery is the route for large external disease and fixed prolapse.
Also agreed: internal hemorrhoids sit inside the rectum while external ones form under the skin around the anus, a clot in an external one gives a painful firm bluish lump, and that a single session of banding generally treats just one column at a time.
That is a solid foundation, and it is what every clinical page on this site is built on. The grades guide covers the first part, in office against surgery covers where the line between routes falls, and the symptoms hub covers the second.
Evidence in Montreal
Four disagreements
Where the sources Montreal patients find differ
Success rates
Providers publish about ninety, over ninety-five and more than ninety-nine percent for the same procedure, all self-reported.
Prices
The sourced figures span a factor of five for the same procedure, across different currencies and health systems.
Banding intervals
One source gives four to eight weeks between sessions, another up to three sessions at two-week intervals.
Complication rates
A review gives bleeding and pain as the commonest at 8 to 80 percent, which is a range wide enough to be a warning in itself.
How to read it
What a wide range is telling you
When a published review reports a complication rate of 8 to 80 percent, the useful information in that is not the midpoint. It is that the underlying studies measured different populations, different procedures and different definitions of a complication, and that averaging them would produce a number describing nothing at all.
The same logic applies to the success rates. Three providers publishing ninety, ninety-five and ninety-nine percent for one procedure are not reporting a consensus with noise around it; each is reporting its own practice, with its own definition of success, and with no external check on either.
So the honest move is to carry the spread rather than the average. Choosing a clinic covers what to make of a clinic that quotes one figure anyway, what treatment costs applies the same reasoning to money, and why they come back applies it to durability.
Three, all differingSuccess rates published
A factor of fivePrice spread
NothingAveraged here
Applied
Where this reasoning shows up in Montreal
The pages that decline to quote a figure, and the one that tells you what to make of a clinic that does.
What people ask when they have read three pages giving three different numbers.
Because each is self-reported, with the provider choosing its own definition of success and no external check. Three clinics publishing ninety, ninety-five and ninety-nine percent are not reporting one finding.
There is, and quite a lot of it. The grading system, which procedures suit which grades, and where surgery takes over are all well agreed. The disagreements are about numbers rather than about mechanisms.
Treat the width as the message. A complication range spanning most of the scale tells you the underlying studies measured different things, not that the true answer is in the middle.
Because an average of measurements that defined their terms differently describes nothing real. It would read as more precise than the sources it came from, which is the opposite of useful.
One review notes that complication and recurrence rates after sclerotherapy can be higher. Beyond that single point, there is nothing clean enough to rank the procedures by.
Be curious rather than hostile. Ask where the figure came from, how success was defined, and over what period. A clinic that can answer those three is giving you something real.
The evidence
Why this site carries the spread
Mechanisms are agreed
Grading, which procedures suit which grades, and where surgery takes over are all well settled.
Numbers are not
Success rates, prices, intervals and complication rates all disagree sharply between published sources.
Width is the message
A range spanning most of the scale tells you the studies measured different things, not where the truth sits.
Three questions to ask
Where a quoted figure came from, how success was defined, and over what period. All three should be answerable.
Bring the three questions from this page to any consultation, here or elsewhere. A clinic that can answer them about its own figures is worth more than one with better figures.
