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For more advanced cases, surgical options performed by colorectal surgeons include hemorrhoidectomy (the most effective but also the most invasive), stapled hemorrhoidopexy, and Doppler-guided hemorrhoidal artery ligation (HAL)

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Pre-Use Checklist Before using any B12 nasal spray: Talk to your healthcare provider if you have: Leber’s hereditary optic neuropathy A known allergy to cobalt or B12 (cyanocobalamin or methylcobalamin) History of severe megaloblastic anemia, polycythemia vera, or bone marrow disorders Low iron or folate, significant kidney issues, or are on chemotherapy agents Persistent nasal congestion, chronic sinus issues, or recurrent upper respiratory infections Review your medications and supplements , especially: Chloramphenicol Omeprazole and other PPIs Aminosalicylic acid Colchicine Bone marrow-suppressing drugs Step-By-Step Administration For best results with a methyl b12 nasal spray such as Synchronicity Health’s formula: Avoid hot food and drinks Do not eat or drink hot liquids for at least 1 hour before and 1 hour after using the spray