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Management
Overview of Hemorrhoids
Hemorrhoids remain one of the most common colorectal complaints. It has been estimated that 50% of the population has hemorrhoids by the age of 50 years.1 Hemorrhoidal disease results from the pathological enlargement and distal displacement of the upper hemorrhoidal plexus. Although they are often asymptomatic, hemorrhoids may cause bleeding, prolapse and pain.2
Current guidelines recommend a minimum of anoscopy and flexible sigmoidoscopy for bright-red rectal bleeding. Most hemorrhoid patients can be managed non-surgically. Surgery is reserved for patients with third and fourth-degree hemorrhoids and failure of nonoperative treatment. A new method of the stapled hemorrhoidectomy significantly reduces postoperative pain, hospital stay and use of analgesics.2
Classification of Hemorrhoids
Hemorrhoids can be broadly classified into internal and external. Internal hemorrhoids originate from the internal venous plexus above the dentate line while external hemorrhoidsoriginate from the external plexus below the
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Etiology ( Causes of Hemorrhoids)
The exact cause of hemorrhoids has not been determined. However, several factors contribute to their etiology. Low dietary fiber intake, malnutrition with constipation, reduced physical activity and hereditary predisposition seem
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Presentation and Diagnosis of Hemorrhoids
Signs and symptoms of hemorrhoids are the result of vascular congestion that occurs when veins become engorged secondary to obstructed blood flow. The symptoms include rectal bleeding, protrusion and swelling of tissue outside the anal canal and itching secondary to inflammation. These symptoms are nonspecific. Conditions such as inflammatory bowel disease and cancer can mimic hemorrhoidal symptoms. Unless the protrusion becomes thrombosed, infected or ulcerated, it is usually painless.
Patients with severe pain or incarcerated protrusions should be seen promptly. Diagnosis is established with direct visualization by anoscopy or proctoscopy. Since most bright red bleeding originate within the reach of a flexible sigmoidoscope, patients should undergo flexible sigmoidoscopy and anoscopy to rule out other causes of bleeding.
Management of Hemorrhoids
Conservative treatment of hemorrhoids consists of dietary and lifestyle modifications. Patients are encouraged to sit in warm water or baths for 15 min, three to four times a day. The over-the-counter pharmacologic agents
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Written by: Healthplus24 team
Date last updated: December 30,2008
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- Orlay G. Hemorrhoids--a review. Aust Fam Physician. 2003; 32(7): 523–526.
- Smud D, Kekez T, Majerović M ,Smud S. Hemorrhoids—diagnosis and treatment options. Lijec Vjesn. 2005; 127(5–6): 129–133.
- Pühse G, Raulf F. Hemorrhoidal suffering. Urologe A. 2007; 46(3): W303–314.
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