Initial treatment for internal hemorrhoids is conservative (psyllium or other bulking agents, avoidance of straining, and decreased toilet time). Invasive therapy is indicated in patients for whom conservative management fails or who cannot tolerate symptoms. Grade 1 hemorrhoids are rarely symptomatic but may be effectively treated with injection sclerotherapy or rubber band ligation. Grade 2 and grade 3 hemorrhoids can be treated in the office with rubber band ligation, shown here.
![Rubber band ligation of hemorrhoid](http://www.consultantlive.com/image/image_gallery?img_id=2111459&t=1351702503459alt="")
![Rubber band ligation of hemorrhoid](http://www.consultantlive.com/image/image_gallery?img_id=2111463&t=1351702518419alt="")
Photos courtesy of Allen P. Kong, MD and Michael J. Stamos, MD.
