Sixty-seven patients with bleeding Grade 1 hemorrhoids were allocated alternately to receive either injection sclerotherapy or a bulk laxative. In either treatment group one third of patients was constipated with passing hard stools.At 2 weeks, 4 weeks and half a year information on the outcome was obtained from diaries kept by the patients. Injection sclerotherapy proved to be clearly superior than the use of bulk laxative. 36%, 23% and 35% compared to 59%, 58% and 72%, respectively, continued to bleed. An unexpected finding was noted among the constipated. Statistical significance could not be obtained, but the use of bulk laxative may show perhaps even better results than injection sclerotherapy. At 4 weeks and after half a year, the rates were 33% and 36% compared to 50% and 60%, respectively. Among the non-constipated patients injection sclerotherapy is the treatment of choice.At 4 weeks and half a year, only 10% and 24% were still bleeding.When a bulk laxative was taken, the effect was negligibly small. 74% and 94%, respectively, showed no response. Recurrences were fewer after injection sclerotherapy. 21% of patients free of bleeding at 4 weeks became symptomatic again in the following 5 months compared to 54% of such patients using bulk laxative. Again, bulk laxative was of little use in patients without the complaint of constipation, but was as effective as injection sclerotherapy among the constipated. These results are in line with prior histological investigations detailing the value of injection sclerotherapy. However, they are in contrast to a report showing that injection sclerotherapy plus bulk laxative is not more effective than the use of bulk laxative alone. They are also different from a meta-analyis of 18 randomized, controlled clinical trials recommending rubber band ligation as the initial treatment of Grade 1 to 3 hemorrhoids. In addition to showing the place of injection sclerotherapy and bulk laxative in the treatment of Grade 1 lesions, the results of the present investigation emphasize the need to ensure comparability between studies by using similar treatment groups and to monitor bowel habits.

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DefinitionMarisken sind hautfarbene, indolente Knoten bzw. Hautlappen am äußeren Analrand, die sowohl einzeln als auch zu mehreren und zirkulär auftreten können. Sie sind von weicher bis derber Konsistenz; ihr Ausmaß reicht von Linsen-bis zu Kastaniengröße. Vom äußeren Aspekt her erinnern sie an Feigen (franz.

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Definition ICD 10: I 84.6Marisken sind hautfarbene, indolente Knoten bzw. Hautlappen am äußeren Analrand, die sowohl einzeln, zu mehreren als auch zirkulär auftreten können. Sie sind von weicher bis derber Konsistenz und ihr Ausmaß schwankt zwischen Linsen-und Kastaniengröße. Vom äußeren Aspekt her erinnern sie an Feigen (franz.