Hemorrhoid Treatment
The hemorrhoid that used to require surgery, usually does not anymore.
At Palazzo Manzoni in Brescia, hemorrhoidal disease is treated, for the majority of patients, without the classic surgical operation. Foam endosclerosis, radiofrequency, elastic ligation. Led by Prof. Edoardo Cervi, general and vascular surgeon.
Hemorrhoidal disease is treated at Palazzo Manzoni in Brescia by Prof. Edoardo Cervi, general and vascular surgeon. The classic Milligan-Morgan hemorrhoidectomy, described in 1937 and once the surgical default, has today been replaced for most patients by ambulatory techniques: foam endosclerosis (injection of a sclerosing agent that produces immediate retraction of the hemorrhoidal cushion), radiofrequency, and elastic ligation. The first consultation grades the disease and chooses the technique.
Ambulatory, no general anaesthesia
Walk in, walk out, return to daily activity.
Surgery rarely required
Endosclerosis and radiofrequency resolve most grades.
Same visit, examination and grading
The plan is built in the first consultation.
A vascular surgeon, not only a proctologist
Hemorrhoidal disease is a venous problem.
What Brought You Here
Roughly half the population will deal with this. Most don’t talk about it.
You’ve adapted. You’ve changed how you sit on long drives. You’ve watched what you eat the day before a flight. You’ve kept tubes of cream in three places. You may have had one acute episode, where the pain was beyond what you’d believed possible from this kind of problem, and you swore the next day you’d see someone. Then it settled. And you went on.
If you’ve reached this page, the working-around-it phase is over. What you need now is a specialist who will examine the area properly, grade the disease, and tell you honestly what each technique would do for you.
About half the adult population deals with hemorrhoidal disease at some point in their life. The conversation is more common than the silence around it suggests, and the treatment is much less of an event than you may fear.
A Clear Path Forward
A precise grading, then the right technique for your specific picture
Hemorrhoidal disease is a venous problem of the rectal cushions. It is, in this sense, a problem of phlebology applied to a particular district of the body. The grading on examination (and where indicated anoscopy or rectoscopy) determines which technique fits. For most patients today, the right technique is not surgery.
Hemorrhoidal disease is treated by Prof. Edoardo Cervi, general and vascular surgeon with phlebology subspecialisation. The same specialist who carries out the consultation carries out the procedure.
01
A vascular surgeon treats the venous problem
Prof. Cervi is a general and vascular surgeon with phlebology subspecialisation. Hemorrhoids are a venous condition at heart. The same hands that close a saphenous trunk with foam sclerotherapy close a hemorrhoidal cushion with endosclerosis.
02
Endosclerosis with foam, the technique that retracts the cushion
The injection of a sclerosing foam into the cushion produces an immediate retraction of the hemorrhoid and a progressive obliteration of the underlying vessel. Indolent, ambulatory, no general anaesthesia, immediate return to the day.
03
Radiofrequency where the indication is right
For selected grades and patient profiles, radiofrequency offers a complementary or alternative ambulatory option, with the same return-to-activity profile.
04
Honest about when surgery is still the right answer
A small minority of advanced cases still require a formal hemorrhoidectomy. When that is the right answer, it is said clearly, with the reason. The default conversation, however, is no longer surgical.
What You Might Be Experiencing
Different presentations,
different conversations
Hemorrhoidal disease is not a single condition with a single technique. The grade, the pattern of symptoms (bleeding, prolapse, mixed), the size of the cushions, and your history all shape the choice. Two ambulatory techniques, chosen by indication, cover the substantial majority of pictures.
Here is how they compare. The choice is made with you, after a proctological consultation that grades the disease.
Technique 01
Foam endosclerosis for hemorrhoids
Best for
Intermittent bright red bleeding with minimal or no prolapse, typically grade I to II disease. For most patients, the right first answer.
Feels like
Indolent. A 10 to 20 minute ambulatory injection, no general anaesthesia, with the cushion visibly retracting during the procedure itself.
Recovery
Same-day return to work and normal activity. One session is often sufficient; two or three for more advanced grades.
Trade-offs
Does not address external hemorrhoidal components, managed separately where present. Recurrence is possible if lifestyle factors are unchanged.
Technique 02
Radiofrequency for hemorrhoids
Best for
Selected grade II to III pictures with reducible prolapse, and mixed bleeding-and-prolapse cases where one technique can address both components.
Feels like
Well tolerated. A 15 to 30 minute ambulatory procedure, no general anaesthesia, with a controlled application of energy through a fine probe under direct vision.
Recovery
Same-day return to office work and normal activity. One session is often sufficient; two sessions four to six weeks apart for more complex pictures.
Trade-offs
Does not address external hemorrhoidal components, managed separately where present. Recurrence is possible if lifestyle factors are unchanged.
Which one is yours?
That’s what the consultation is for.
Your Journey
From “I’ve been avoiding this for years”
to the problem is no longer part of my day.
Step 01
Your first proctological consultation
A focused history (the pattern of bleeding, prolapse, pain, the duration), an examination, and anoscopy or rectoscopy where indicated. The visit is conducted in the privacy and dignity the conversation deserves. The disease is graded.
Step 02
Your personalised plan
You leave the first visit with a clear grading, a recommended technique (foam endosclerosis, radiofrequency, in selected cases elastic ligation, very rarely now formal surgery), and an estimate of how many sessions to plan for.
Step 03
The procedure
Performed at Palazzo Manzoni by Prof. Cervi. Foam endosclerosis: ambulatory, no general anaesthesia, typically 10 to 20 minutes, with the immediate retraction of the cushion visible during the procedure itself. Radiofrequency: ambulatory, brief, with no incision. Return to daily activity, including work, the same day.
Step 04
Aftercare and follow-up
A few days of attention to bowel habit and hydration, occasional use of mild analgesics where required. The acute symptoms typically resolve within days, not weeks. A control visit follows at the agreed interval; where additional sessions are required, they are scheduled four to six weeks apart.
What It Looks Like On The Other Side
A day that doesn’t have to be
planned around the bathroom
The first thing most patients notice isn’t the absence of bleeding. It’s the absence of the calculation. The long drive that doesn’t begin with a quick risk assessment. The meal that doesn’t end with low-grade dread. The bathroom visit that is no longer an event with consequences.
In their own words
“Bleeding for fifteen years. I’d avoided dealing with it for fifteen years. One session of foam endosclerosis, no general anaesthesia, walked out within the hour. The bleeding stopped within days.”
“The prolapse had become a daily problem. I was expecting to be told the operation was the only answer. Prof. Cervi proposed radiofrequency. Ambulatory. The difference was immediate.”
“Two other doctors had told me Milligan-Morgan, with the recovery that goes with it. Prof. Cervi explained why endosclerosis with foam was the right first answer for my grade. He was right. The operation didn’t have to happen.”
When Time Is Not Neutral
Most hemorrhoids can wait. None benefit from being ignored for years
Hemorrhoidal disease is rarely an emergency. It is, however, a progressive condition. Grades that respond cleanly to a single session of foam endosclerosis in their early stage may require a more complex pathway later. A chronically bleeding hemorrhoidal cushion can lead to iron-deficiency anaemia. A prolapse that reduced spontaneously last year may, after another year of being worked around, no longer reduce.
None of this is a reason for alarm. It is a reason for the first consultation. There is one important caveat: blood from the rectum should never be assumed to be hemorrhoidal without an examination. Other causes of rectal bleeding, some of them serious, must be excluded clinically. The first proctological consultation is the visit that does that exclusion and produces the right diagnosis.
→Foam endosclerosis
The ambulatory first answer for grade I to II bleeding-dominant disease — the cushion retracts during the procedure itself.
→Radiofrequency
For selected grade II to III pictures with reducible prolapse — addresses both bleeding and prolapse in a single ambulatory session.
→Elastic ligation
A small elastic band placed at the base of the cushion under anoscopy, often combined with endosclerosis for grade II to III disease.
→Milligan-Morgan hemorrhoidectomy
The classic surgical operation, today reserved for the minority of advanced cases unsuitable for minimally invasive techniques.
Entrust yourself to a specialist sooner: the fewer years you carry the problem, the less of a problem it remains.
Common Questions
Common questions
about hemorrhoid treatment
How do I know if my problem is hemorrhoidal?
The typical presentations are intermittent bright red bleeding during or after a bowel movement, prolapse of a swelling that may or may not reduce spontaneously, itching, and a feeling of weight (tenesmo). All of these can have other causes, however, which is why the first specialist visit includes an examination and anoscopy or rectoscopy where indicated. The diagnosis is clinical and confirmed by the examination.
Will I need surgery?
For most patients today, no. The Milligan-Morgan hemorrhoidectomy, described in 1937, remains the gold-standard surgical operation, but the majority of hemorrhoidal pictures (grade I to III, and even selected grade IV) are now treated with ambulatory techniques: foam endosclerosis, radiofrequency, elastic ligation. Surgery is reserved for the minority of advanced cases that have not responded to less invasive options or in which the anatomy demands it.
What is foam endosclerosis, and is it painful?
Endosclerosis with foam is the injection of a sclerosing agent in foam form directly into the hemorrhoidal cushion through a fine instrument. The foam produces an immediate retraction of the cushion (visible during the procedure) and a progressive obliteration of the underlying vessel. The procedure is ambulatory, takes 10 to 20 minutes, requires no general or spinal anaesthesia, and is described by most patients as indolent.
What is radiofrequency for hemorrhoids?
Radiofrequency uses a controlled application of energy to the hemorrhoidal tissue, producing a coagulation effect that addresses both bleeding and prolapse. Like endosclerosis, it is ambulatory and does not require general anaesthesia. It is preferred for selected grades and patient profiles.
How many sessions are required?
For foam endosclerosis, often one session is sufficient. For more complex pictures, a short cycle of two or three sessions, typically four to six weeks apart, may be planned. The exact number is established after the first consultation.
When can I return to my activities?
The same day. Most patients return to work the day of the procedure or the day after. Strenuous physical activity and long flights are best avoided for a few days. Pain, where present, is mild and well controlled.
Is rectal bleeding always hemorrhoidal?
No. This is an important caveat. Rectal bleeding can have other causes, some of them serious, and the first specialist visit is the one that excludes them clinically. The examination and anoscopy or rectoscopy are part of this exclusion.
Can hemorrhoidal disease come back after treatment?
Recurrence is possible, particularly if the lifestyle factors that contributed to the disease (low fibre intake, prolonged sitting, chronic straining) are unchanged. The treatment closes the diseased cushion; lifestyle adjustment reduces the probability that a new cushion develops a similar problem. The two are discussed together at the consultation.
How long has this kind of treatment been available?
Endosclerosis as a technique has been used since the 19th century, with modern foam variants developed and refined over the last two decades. Radiofrequency for hemorrhoidal disease is more recent. Both have a substantial clinical track record. The classic Milligan-Morgan operation, by contrast, dates from 1937 and remains essentially unchanged.
How much does the treatment cost?
Cost depends on the technique, the number of sessions, and the inclusion of anoscopy or rectoscopy. After the first proctological consultation, you receive a clear, transparent estimate covering the diagnosis, the procedure, and any planned follow-up.
Where is Palazzo Manzoni, and do I need a referral?
Istituto Chirurgico Palazzo Manzoni is at Via dei Mille 14 in central Brescia. No referral required to book a proctological consultation. You can book directly by phone, email, or online form.
Who treats hemorrhoidal disease at Palazzo Manzoni?
Hemorrhoidal disease is treated by Prof. Edoardo Cervi, general and vascular surgeon with phlebology subspecialisation. The same specialist who carries out the consultation carries out the procedure.
Take the Next Step
The problem you’ve been avoiding
has a short, ambulatory answer.
At Palazzo Manzoni in Brescia, your proctological consultation is thorough, honest, and conducted with the privacy and dignity the conversation deserves.
Address
Via dei Mille 14, 25122 Brescia, Italia
Phone
Hours
Mon-Fri 8:30-18:30 · Sat 9:00-13:00
01
Get in touch
Call, email, WhatsApp, or book online.
02
Be examined and graded by Prof. Cervi
A 20 to 30 minute visit, in privacy.
03
Move forward, with a plan
A plan that for most patients is no longer surgical.
Content reviewed by Prof. Edoardo Cervi, head of Vascular Surgery.