- Affect 50% of population over the age of 50 years
- Usually presents with:
- Painless bright red rectal bleeding
- Prolapsing perianal lump
- Acute pain due to thrombosis
- Faecal soiling or pruritus ani
- The following factors appear important:
- 80% of patients have high resting anal pressure
- Haemorrhoids are often classified as internal or external
- Internal haemorrhoids arise above the dentate line and can be sub-classified as
- First degree - bleeding only
- Second degree - prolapse, reduce spontaneously
- Third degree - prolapse, pushed back
- Fourth degree - permanently prolapsed
Picture provided by J M Enriques-Navascies, Hospital Donostia, San Sebastian, Spain.
Picture provided by Michael Rudd, Royal Brisbane Hospital, Brisbane, Australia
- All should have high residue diet
- Local preparations rarely produced long-term clinical benefit
- Treatment options for first and second degree haemorrhoids include:
- Injection with 5% phenol in arachis or almond oil
- Rubber band ligation
- Randomised trial of rubber band ligation and sclerotherapy have shown
- 90% success with rubber band ligation
- 70% success with sclerotherapy
- Treatment options include:
- Dilatation and banding
- Haemorrhoidectomy is usually performed as an open procedure (Milligan-Morgan)
- Secondary infection and postoperative pain may be reduced with oral metronidazole
- Botulinum toxin injection may also reduce postoperative pain
- Complications include bleeding (3%), urinary retention (10%)
- Anal stenosis may develop adequate skin bridges are not maintained
- Other haemorrhoidectomy techniques include closed or stapled procedures
- The recently described stapled technique is associated with:
- Reduced operating time
- Less postoperative pain
- Shorten hospital stay
- More rapid return to normal activity
Pictures provided by Reda Saad, El Demerdash University Hospital, Cairo, Egypt
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