Grade of prolapse and symptoms of haemorrhoids are poorly correlated: result of a classification algorithm in 270 patients

Abstract

This anatomical classification, based on strict criteria, reliably staged the haemorrhoid prolapse. There was no unique preoperative symptom profile associated with any degree of prolapse with or without an external component. Restored anal anatomy relieved symptoms. The classification also defined recurrence of haemorrhoids.

A Randomized Trial of Transanal Hemorrhoidal Dearterialization With Anopexy Compared With Open Hemorrhoidectomy in the Treatment of Hemorrhoids

“…2). a peak pain score of more than 3 was reported for a median of 7 days (range, 0-13) in the thD/a group in comparison with 12 days (range, [5][6][7][8][9][10][11][12][13][14] in the oh group (p = 0.010) the overall pain did not differ between the groups (fig. 3).…”

“…Because no validated questionnaire for hemorrhoidal disease was available, we used a questionnaire used in clinical practice and in previously published studies. 12 the frequency of each symptom (never, less than once a week, 1-6 times per week, and every day (always)) was reported. stratification for irritable bowel syndrome was done according to the Rome 3 criteria.…”

“…a clinical evaluation was performed (by C.l.) after 8 to 12 weeks (median, 12; range, 9-23) and after 12 months (median, 12; range, [11][12][13][14][15]. the grade of hemorrhoids was estimated, and the patients answered the same questionnaire as before surgery.…”

Transperineal ultrasound in the assessment of haemorrhoids and haemorrhoidectomy: a pilot study

“…It is recognized that grade II haemorrhoids may be misclassified as grade III and that grade IV haemorrhoids are difficult to categorize where there is a significant external component which is either misdiagnosed as internal prolapse or which is not incorporated into the standard clinical classification [18]. Clinical or radiological assessment of haemorrhoids is further complicated by the relatively poor correlation between symptoms, (bleeding and prolapse) and grade, although Gerjy et al [19] have been able to show an effect on symptoms by the reduced grade resultant from surgery. In this context, clinicians are more influenced by the size of the haemorrhoids rather than the reported symptom of the need for manual replacement, where there is a bias towards operative therapies for more advanced stage and an assumption that conservative therapies are less efficacious for larger clinical grades.…”

The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation

“…90 We feel that the significant lengths to which we have gone to carefully define recurrence should be regarded as a strength. Our data provide a clinically meaningful result of the true incidence of recurrence that is primarily patient reported, but has taken into account clinician-derived data of further consultations and procedures.…”