Bipolar diathermy involves the use of electrical current to coagulate the hemorrhoids, including the mucosa and submucosa. The machine generates a 2-second pulse of energy to accomplish the treatment. This approach is applicable for small bleeding hemorrhoids and probably has no greater efficacy than sclerosing.
Other variations on the use of energy to scarify internal hemorrhoids and fix them to underlying tissues includes infrared coagulation and direct current therapy or Ultroid (Microvasive, Boston, MA) therapy. Infrared coagulation uses a tungsten halogen lamp that generates heat energy for 1.5 seconds, resulting in destruction of the mucosa and submucosa at the application site . The depth of penetration of this injury is usually 3 mm. Conversely, the Ultroid uses electrical current that is applied for up to 10 minutes per complex treated. Ultimately, these new modalities are a variation on the theme of local tissue destruction and fixation of the hemorrhoids at the appropriate level.
