Management of haemorrhoids

• Published in: BMJ Vol. 336; no. 7640; pp. 380 - 383
• Main Authors: Acheson, Austin G, Scholefield, John H
• Format: Journal Article Book Review
• Language: English
• Published: London British Medical Journal Publishing Group 16-02-2008; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ Publishing Group Ltd
• Edition: International edition
• Subjects: Arteries; Biological and medical sciences; Bleeding; Clinical Review; Colorectal cancer; Dietary supplements; Experimentation; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Hemorrhoids; Hemorrhoids - diagnosis; Hemorrhoids - etiology; Hemorrhoids - therapy; Humans; Large intestine; Ligation; Ligation - methods; Medical sciences; Medical treatment; Other diseases. Semiology; Outpatient treatment; Pain; Patients; Rectum; Rubber bands; Sclerotherapy - methods; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Surgical Stapling; Symptoms; Varicose veins; Vein & artery diseases; Veins & arteries; Vascular disease; Medicine; Clinical management; Cardiovascular disease; Digestive diseases; Intestinal disease; Hemorrhoid; Anorectal disease; Venous disease
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.39465.674745.80

Tips for non-specialists Haemorrhoids are common in all age groups Most patients can be treated in primary care with dietary advice and avoidance of straining Patients with rectal bleeding alone who are over 40 should be referred to a specialist for imaging of the colon All patients with haemorrhoids who have symptoms in the lower gastrointestinal tract-such as change in bowel habit, abdominal pain, or tenesmus-must be referred to a specialist Anal cancer can have a similar appearance to a prolapsed haemorrhoid How are haemorrhoids treated? The evidence from a recent meta-analysis suggests that the procedure is less painful and safe, and that hospital stay is shorter, with a more rapid return to normal activities. 22 Long term follow-up studies suggest that recurrence rates are higher after stapled haemorrhoidopexy than after conventional haemorrhoidectomy. 23 One early trial reported severe postoperative pain and faecal urgency after the stapled procedure, however, but this has not been seen in other studies. 24 Other possible complications include bleeding, urinary retention, faecal incontinence rectal perforation, rectovaginal fistulas, anastomotic leak, anal stricture, and severe pelvic sepsis. 14 This technique can be offered to patients with second or third degree haemorrhoids that have not responded to outpatient treatment or even fourth degree haemorrhoids that are reducible under anaesthesia.