Hemorrhoids

ABSTRACT

Hemorrhoids are fibrovascular cushions that develop as a result of chronic straining at stool. They generally present with bleeding or prolapse. In contradistinction to popular belief, internal hemorrhoids rarely cause pain.

For the majority of individuals with minimally symptomatic hemorrhoids, changes in defecatory habits, particularly eliminating constipation, will resolve their symptoms. For individuals with more advanced disease, office treatment such as banding, scleral therapy, or photocoagulation may be necessary. In rare circumstances, individuals with refractory hemorrhoids may require surgical hemorrhoidectomy. This is associated with significant postoperative pain but is also very successful at eliminating symptoms.

Two new developments have recently occurred in the treatment of hemorrhoidal disease. A small suction ligator that does not require anoscopic exposure has been described in a small number of patients. It may expand the indications for banding, particularly in individuals who tolerate anoscopic exam poorly. In addition, stapled hemorrhoidectomy has been described for the treatment of complex hemorrhoidal disease. In three small randomized trials, it has been associated with less postoperative pain, shorter hospitalization, and faster return to normal function.

KEYWORD

Hemorrhoids - banding - stapled hemorrhoidectomy

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