Electrocautery or Infrared Coagulation for Treatment of HSIL

Introduction: Electrocautery (EC) or Infrared Coagulation (IRC) has been shown to be an effective treatment for internal anal warts, low-grade (LSIL) and high-grade (HSIL) anal intraepithelial neoplasia. The treatment involves the application of a hand held tip directly to the abnormal lesions. The heat source destroys the surface cells, which can then be removed. It can be done as an office treatment with minimal discomfort. Post-treatment recovery is brief and there are fewer risks than with surgical intervention. Extensive disease may require additional treatments. A follow-up HRA is scheduled three to six months following the procedure. If there is too much to treat in one session, your treatment may be completed at the next visit.

Pre-treatment preparation & medication: You should try to have a bowel movement prior to your appointment, but no special rinsing out or enema is required. Some patients prefer to have mild sedation before the procedure, but it is usually not required. If you prefer to be sedated, please provide us with the name of your local pharmacy so that a prescription of two 1 mg tablets of Ativan (used for short term relief of tension) can be called in for you. Take one tablet 1 hour prior to your appointment and take the 2nd tablet a ½ hour prior to your appointment. You need to be accompanied to and from your appointment if you use this medication.

Treatment: After signing a consent form to verify that you understand and agree to the destruction procedure, you will be treated with numbing gel (tetracaine/lidocaine/prilocaine) in the treatment area. You will then be injected with more numbing medication (lidocaine) on or near the specific lesions to ensure you are completely numb before beginning the treatment.

After treatment instructions: Depending on the extent of the treatment, most, but not all people will have some mild to moderate discomfort which can last a few days and up to 7 to 10 days following the treatment. Most of the discomfort is associated with bowel movements.

  • Take 600 mg ibuprofen (Advil) every 6 hours OR naproxen (Aleve) 2 pills every 8 hours for the first 1-3 days or longer if needed for pain.
  • Add Regular Strength Tylenol 2 pills every 6 hours as needed and take with the ibuprofen or naproxen if pain persists. If pain medication was prescribed, you can take this with the ibuprofen/naproxen and tylenol but only if needed since this can cause constipation.
  • Start Colace 100 mg capsule orally once a day for 2 weeks if stools are firm. You may take Colace 1 capsule twice a day if the stools are not soft enough or 1 capsule every other day if stools are runny. The goal is to keep the stool soft. Pain medications can be constipating. Consume a diet rich in fruits and vegetables and increase your fluid intake. It is best to avoid hot and spicy foods.
  • Soak in a hot bath for 5-10 minutes every 2-4 hours as needed starting today. It is most soothing after bowel movements and can relieve spasm and swelling. The bath feels good and helps you heal faster as the heat brings more blood flow to the area.
  • Plan to take it easy for a few days so no vigorous workouts or heavy weight lifting.
  • Following treatment there is frequently small amounts of bleeding with bowel movements. You will notice a little more bleeding around 1 week after treatment as the scabs come off.
  • Do not insert anything into the rectum or the anal canal for at least 3 WEEKS after your treatment. Resuming sex too soon may cause tearing or additional bleeding.

Post-treatment discomfort and bleeding varies from patient to patient and may last for several weeks. Please communicate with me if pain relief is not achieved through medication or other comfort measures mentioned above, or if you are experiencing heavy bleeding.

It may take several treatments to clear the precancerous lesions. HPV can come back causing further problems. You may not need more treatment now, but there is also a chance that a problem could develop in the future. Please keep all follow-up appointments to insure that you have healed and that nothing else has developed.

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