Haemorrhoids: modern diagnosis and treatment

Abstract

Haemorrhoids present often to primary and secondary care, and haemorrhoidal procedures are among the most common carried out. They may co-exist with more serious pathology, and correct evaluation is important. In most cases a one-off colonoscopy in patients aged 50 or above with flexible sigmoidoscopy in younger patients is reasonable. Many people with haemorrhoids do not require treatment. Topical remedies provide no more than symptomatic relief-and even evidence for this is poor. Bulk laxatives alone may improve symptoms of both bleeding and prolapse and seem as effective as injection sclerotherapy. Rubber band ligation is effective in 75% of patients in the short term, but does not treat prolapsed haemorrhoids or those with a significant external component. Conventional haemorrhoidectomy remains the most effective treatment in the long term, the main limitation being post-operative pain. Metronidazole, topical sphincter relaxants and operative technique have all been shown to reduce pain. Stapled haemorrhoidectomy and haemorrhoidal artery ligation techniques are probably less effective but less painful. Long-term data are poor for all procedures, with many studies reporting only 1-3 years of follow-up data. Haemorrhoids are common in pregnancy, occurring in 40% of women. They can usually be treated conservatively during pregnancy, with any treatment delayed until after delivery. Acutely strangulated haemorrhoids may be treated either conservatively or operatively. There is an increased risk of anal stenosis after acute surgery, but the risks of sepsis and sphincter damage are less significant than previously thought. The majority of patients who are treated conservatively will still require definitive treatment at a later date.

Hemorrhoidal disease and chronic venous insufficiency: Concomitance or coincidence; results of the CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research)

“…Nonsurgical approaches are preferred for lower grade hemorrhoids because of the physiologic importance of the hemorrhoid cushions and potential self‐limiting nature of many hemorrhoid symptoms . When conservative therapy fails, clinical practice guidelines recommend office‐based procedures such as banding, sclerotherapy, and infrared coagulation for Grade I to III hemorrhoids .…”

Comparison of Transanal Suture Rectopexy With Stapled Haemorrhoidopexy in Patients of Haemorrhoids: A Randomized Control Trial

“…Newer techniques like DGHAL and stappled haemorrhoidopexy avoids the removal of these important anatomical structures 11 . Still, the procedures which involve haemorrhoidectomy have low recurrence but more pain 13 while the procedures which do not involve haemorrhoidectomy causes less pain but have more recurrence 14 .…”

Hemorrhoids in pregnant and postpartum women: principles of therapy

“…В даль-нейшем присоединяются такие симптомы, как боли, уве-личение геморроидальных узлов, кровотечение, аналь-ный зуд и др. [6][7][8].…”

“…Чем продолжительнее период родовой деятельно-сти, тем более выражены эти процессы. После родов проис-ходит постепенное сокращение сфинктера заднего прохо-да, внутренние узлы уменьшаются и самостоятельно вправ-ляются, но при быстром сокращении сфинктера возможно ущемление узлов и развитие острого геморроя [5,7,9].…”