Infrared coagulation in Montreal, under direct view
An alternative office procedure that works by coagulating the tissue rather than by cutting off its supply with a band. It is applied under direct visualisation through an anoscope, and nothing is left in place afterwards.
Infrared coagulation applies energy directly to the hemorrhoid through an anoscope, under direct visualisation, so the clinician is looking straight at the target while it is being treated. The effect is on the tissue itself rather than on the vessel that feeds it.
That is the real difference from banding, where a band goes on at the base and the tissue above it withers because its blood supply has gone. With infrared there is no band placed and nothing left behind to come away days later.
Which of the two suits you is a question about size and position rather than about one of them being stronger. Both sit in the same group of office procedures for grades one to three, internal disease covers how that grading is established, and the grades guide covers each stage.
Montreal procedure
The appointment
The Montreal infrared session, step by step
Positioned and examined
The anoscope goes in first, because the whole point of this procedure is that the target is visible while it is treated.
Applied directly
Energy is applied to the hemorrhoid itself under direct view, in short bursts rather than in one go.
Checked as it goes
Because the clinician is watching the target throughout, the effect is assessed during the procedure rather than afterwards.
Out the same visit
No band is left in place, so there is nothing to come away later and no general anaesthetic involved.
Choosing between them
When this is the better of the two
Neither procedure is the stronger one in general, and anywhere presenting it that way is simplifying things for the sake of a sale. The sensible way to read the choice is that each one has presentations it fits, and the examination is what identifies which of them you actually have.
Size and position do most of the deciding here. So does what is already known about how you respond, if you have had something done before. None of that can be settled before someone has looked, which is why no option gets promised over the phone here.
What people ask when they have been offered this rather than banding and want to know why.
Banding places a band at the base so the tissue above loses its supply and drops off. Infrared treats the tissue directly under view through an anoscope, and leaves nothing in place afterwards.
That is the wrong frame. Both sit in the same group of office procedures, and which suits you depends on the size and position of what is there rather than on one being stronger.
Usually because of what the examination found: the size and position of the hemorrhoid, and sometimes what has already been tried. Ask at your visit, because the reason should be specific to you.
Neither is described as painful in the sharp sense, and both are done without a general anaesthetic. What people notice afterwards differs between individuals more than it does between the two procedures.
Possibly, for the same reason as banding: more than one column is often involved. The number comes from your examination rather than from a figure on this page.
No. Unlike banding, nothing is placed and nothing is left behind, so there is no band to come away in the days afterwards and nothing to notice.
Infrared coagulation
Why we do not call it the best one
Direct visualisation
The anoscope is in place throughout, so the target is visible while it is being treated rather than afterwards.
Nothing left behind
No band is placed, so there is nothing to come away in the following days and nothing to notice.
Not ranked, matched
Size and position decide between the office procedures. A clinic ranking them for you is simplifying for a sale.
Same grade range
It sits in the same group as banding and sclerotherapy, for grades that have not settled conservatively.
The choice between the office procedures comes out of the examination rather than out of a preference. Tell us the symptoms and we will settle it at the visit.
