Objective To explore the clinical effect of endoscopic sclerosing agent injection combined with ligation in the treatment of third degree internal hemorrhoids.Methods 100 patients with internal hemorrhoids from January 2019 to August 2022 were prospectively selected and divided into control group (50 patients, treated with ligation) and study group (50 patients, treated with endoscopic sclerosing agent injection combined with ligation). Clinical data of patients were collected, and the clinical efficacy, postoperative recovery related indicators, resting anal pressure, anal canal maximum systolic pressure (AMSP), degree of hemorrhoid prolapse and the incidence of postoperative complications were compared between the two groups.Results The total effective rate of the study group was higher than that of the control group, and the difference was statistically significant (P < 0.05); After surgery, the pain score, wound bleeding score, degree of hemorrhoid prolapse score, and anal edema score in the study group were lower than those in the control group, and the differences were statistically significant (P < 0.05). After operation, the resting anal pressure and AMSP in both groups were obviously reduced, and the study group was lower than the control group (P < 0.05).Conclusion The combination of endoscopic sclerosing agent injection combined with ligation for the treatment of internal hemorrhoids has a significant effect, which can improve the recovery of surgical and postoperative related indicators, improve the anal and intestinal dynamics, reduce the score of hemorrhoid prolapse, and have good safety.