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PubMed2005

Prescription pattern for treatment of hemorrhoids under the universal coverage policy of Thailand.

The Universal Coverage Policy (UCP) or "30 Baht Scheme" was launched in Thailand in 2001. The policy caused a cutback in the budgets of all public hospitals and health service centers. Traditional medicine was then viewed as an alternative to save costs. This study examines whether this had any influence on hemorrhoid treatment prescription patterns, ratio of traditional/modern medicine, or the cost of hemorrhoid treatment after the UCP was implemented at a community hospital. The traditional medicine prescribed was Petch Sang Kart and the modern alternative was Proctosedyl. All hemorrhoid prescriptions at a community hospital from October 2000 to January 2003 were surveyed. Segmented Regression Analysis was applied to evaluate prescription trends, the ratios between the types of medicine, and the hemorrhoid treatment cost. A total of 256 prescriptions were analyzed. The average number of traditional medicine prescriptions per month were more than modern medicine (41 versus 16). During the study period, the trend of modern medicine use and the treatment cost was decreased (p < 0.01). The ratio of traditional/modern medicine increased 0.2 times (p = 0.02).

Adolescent↗
PubMed2005

Novel approach to advanced hemorrhoidal disease.

BACKGROUND: There have been many attempts to find a less painful surgical method of treating hemorrhoids as against those available in standard surgical procedures. A novel technique of hemorrhoidal ablation by radiofrequency is described, which is followed by suture fixation of the hemorrhoidal mass. MATERIAL AND METHODS: This non-randomized, retrospective study describes the clinical outcome of the procedure performed in 1650 patients over a period of 5 years. An Ellman dual frequency radiofrequency generator was used for ablation of hemorrhoids. RESULTS: The operation time ranged between 6 to 8 minutes. Mean hospital stay was 9 hours. The immediate postoperative complication included retention of urine, wound infection and perianal thrombosis. The mean period of incapacity for work was 10 days. Late complications included development of anal tags, anal papillae and recurrence in 2% patients. There was no incidence of anal stricture or continence disorder. CONCLUSION: The procedure advocated by the author can be opted as an alternative to conventional surgical procedures. This day care procedure is simple to perform, allows the patients to return to normal activities in a short span of time with lesser pain and has fewer postoperative complications.

Adolescent↗
PubMed2005

The significance of detailed examination of hemorrhoids during pregnancy.

In the population of pregnant women in Serbia and Montenegro, hemorrhoids are present in 85% of the cases during the second and third pregnancy. Urged by the complications of non-treated hemorrhoids, we carried out a routine diagnostic procedure to examine hemorrhoids during pregnancy, i.e. a differential diagnosis with other possible complications was performed. Fifty patients, aged between 36 and 38, were examined by anoscope and rectoscope during the second trimester. Rectal carcinoma was found in three cases, which is a disturbing number. The patient with the most serious clinical picture was subjected to urgent artificial fetal lung maturation and surgical delivery. One of the patients had clinical cachexia, and in view of the fact that the magnetic resonance imaging during pregnancy showed infiltration and that the patient was 38 years old, with the patient's consent, surgery was performed together with hysterectomy and salpingo-oophorectomy and immediate removal of the rectum and anus. In the other two cases, the delivery ended vaginally between the 35th and 38th week of gestation, after which the patients were moved to the surgery ward. Besides a positive family history for digestive tract carcinoma (95%), smoking and increased body mass index, there were no significant parameters distinguishing these three patients from others with hemorrhoids. Interesting data were obtained from the fact that there was no increase in body mass during pregnancy which patients correlated with their already present obesity. Moreover, pain was correlated with the fact that the patients did not follow a healthy dietary regime. In all 50 patients, the following procedures were performed: anoscope, rectoscope and digestive tract tumor markers. Observing the results of the biopsies, we found rectal carcinoma Stage C according to Dukes staging (tumor included serosa) in one case. In the other two cases, Stage B1 carcinomas were found (which included all layers except serosa). Magnetic resonance imaging was performed and confirmed progression of the disease. The delivery ended per vias naturalis in two cases in view of the fact that it was the third pregnancy for both patients. Surgery was performed 40 days after delivery. Postoperative recovery was unremarkable in all described cases.

Adenocarcinoma↗
PubMed1990

[Hemorrhoids. Medico-surgical treatment].

The clinical history of 300 patients examined by the author at San Fernando Clinic and 90 consecutive cases operated at CHMCSS were studied. The frequency and characteristics of symptoms, the gender prevalence, the physical findings, the clinical classification and the various therapeutic methods used were determined. It was noticed that 84% of the patients received conservative treatment and 16% were subjected to surgery. The conservative treatment consisted of high fiber diets, warm sits baths, psyllium, hemorrhoidal sclerosis or ligature with rubber bands. The surgical treatment consisted of the ligature and excision of the three primary hemorrhoids and of the hemorrhoidal plexus(5), which is a simple, fast and effective technique, because the removal of the hemorrhoidal cushion avoids recurrences. Furthermore, the suturing of the longitudinal fibers and the pedicle and their fixation to the external sphincter avoids the upward retraction of the pedicle and the formation of denuded areas in the anal canal that can lead to stenosis at the level of the anorectal ring.

Adolescent↗
PubMed1989

Anal manometric studies in hemorrhoids and anal fissures.

Manometry study with the use of continuous water perfusion system was performed for 50 patients with Grade III or IV hemorrhoids and for 29 patients with chronic anal fissure. Another 36 patients who did not have any anorectal symptom or pathology were chosen as the control group. The maximal basal pressures for the control, the hemorrhoid, and the chronic anal fissure groups were 71.2 +/- 24.9, 85.3 +/- 27.7 and 87.4 +/- 38.8 mmHg respectively; the maximal contraction pressures for the control, the hemorrhoid and the fissure groups were 132.9 +/- 44.9, 158.8 +/- 58.0 and 162.1 +/- 64.5 mmHg; while the lengths of the functional sphincter of the three groups were 3.7 +/- 0.5, 3.8 +/- 0.8 and 3.9 +/- 0.6 cm respectively. The maximal basal pressures and the maximal contraction pressures of the hemorrhoid and fissure patients were significantly greater than those of the control group; whereas the functional sphincter lengths of the three groups did not show significant difference.

Adult↗
PubMed1989

The roles of hemorrhoidectomy and lateral internal sphincterotomy in the treatment of hemorrhoids--clinical and manometric study.

To compare the clinical effect of lateral internal sphincterotomy with hemorrhoidectomy and to examine the change of anal pressure before and after these two treatments, manometric study and clinical symptoms were assessed in 56 patients with hemorrhoids. These patients were randomly allocated to one of the two treatment groups. Another twenty-seven persons with sex and age match were also studied as the normal control. There was no significant difference between the mean resting anal pressure (RAP) of the controls (72.56 +/- 11.93 mmHg) and the hemorrhoid group (75.82 +/- 8.38 mmHg). Thirty-one patients received hemorrhoidectomy and there was no significant reduction of RAP postoperatively. The mean resting anal pressure of the 25 patients receiving lateral internal sphincterotomy was reduced postoperatively (75.1 +/- 9.85 mmHg VS. 70.24 +/- 7.77 mmHg). Although lateral internal sphincterotomy did reduce the anal pressure, the clinical outcome was better in hemorrhoid group. We consider hemorrhoidectomy as the optimal choice in these two kinds of treatment. Change of anal pressure may not play such an important role in the pathogenesis of hemorrhoids.

Adult↗
PubMed1986

Outpatient management of hemorrhoids.

Hemorrhoids are a common medical problem that usually can be managed conservatively with dietary changes, stool softeners, and local hydrocortisone creams. Acutely thrombosed external hemorrhoids require excision of the entire hemorrhoidal mass and the overlying skin. Persistently bleeding or painful internal hemorrhoids are best managed by the technique of band ligation.

Ambulatory Care↗
PubMed1985

Long-term follow-up of concomitant band ligation and sclerotherapy for internal hemorrhoids.

From 1978 to 1983, 111 patients with symptomatic internal hemorrhoids were treated as outpatients by a modification of the Barron ligation technique. Each ligated hemorrhoid was injected with a sclerosant. Follow-up, available for 94 of the patients, ranged from 2 to 60 months (mean 18 months). Presenting symptoms were bleeding in 75 (80%) of the 94 patients, pain in 46 (49%), pruritus in 22 (23%) and prolapse in 24 (26%). Results were excellent in 51 (54%) patients, good in 20 (21%) and fair in 9 (10%). Fourteen (15%) patients had unsatisfactory results; only 4 of these required hemorrhoidectomy. The other 10 had residual symptoms but did not require further treatment. Nine patients had minor complications, which included pain lasting 24 to 72 hours in seven, bleeding in one and syncope in one. The addition of sclerotherapy to traditional band ligation for the management of internal hemorrhoids has the advantages of exciting a greater inflammatory reaction between the mucosa and submucosa and preventing premature slipping of the band. The authors conclude that this method of therapy is effective for symptomatic hemorrhoids and that surgical hemorrhoidectomy is seldom indicated.

Adult↗
PubMed1978

[The importance of hemorrhoids in gynecology and obstetrics (author's transl)].

Hemorrhoids are of enough importance in gynecology and obstetrics that the gynecologist should be well versed in proctologic diagnosis and treatment. In the gynecological office practice about 19% of the patients and in the antenatal practice about 46% of the patients have hemorrhoids which require treatment. Prior to treatment an exact examination with the exclusion of carcinoma of the rectum is important. The indications for different modes of treatment are discussed. Minor hemorrhoids require only general and conservative measures. Recurrent and severe hemorrhoid problems require specific treatment. The specific treatment should be as tolerable for the patient as possible, have few recurrences and be economic regarding time and money. These requirements are best fulfilled by aspiration rubberband ligature or the combination of this ligature with cryotherapy.

Cryosurgery↗
PubMed1978

The relationship between carcinoma of the rectum and hemorrhoids.

The suspected positive correlation between rectal carcinoma and hemorrhoids was examined in a retrospective study. In patients older than 50 a significant positive correlation could be demonstrated between rectal carcinoma and hemorrhoids. In the group of hemorrhoid patients described it could not be shown that rectal carcinoma was more frequent than in the normal population. In patients older than 40 with hemorrhoids a rectoscopy is always recommended. In this material the colonic enema did not contribute any diagnostic information from which therapeutic consequences could be inferred.

Adult↗
PubMed1994

[Rheological parameters in hemorrhoid pathology].

The authors studied erythrocyte aggregation in 62 patients suffering from hemorrhoidal disease, distributed on the basis of proctoscopy findings between three groups (recent uncomplicated congestive attack, recent thrombosed hemorrhoid, stage IIb or III chronic prolapse). This hemorheological parameter is a sensitive marker of circulatory stasis. Values measured were compared with those obtained in 21 healthy subjects. Erythrocyte aggregation index was significantly higher in patients than in controls (31.6 +/- 6.8 versus 27.7 +/- 4.4) (p < 0.05). This difference was due essentially to increased values in patients with acute hemorrhoid problems. A parallel increase in blood fibrinogen was found in these same patients. Hemorheological changes could predispose to worsening of venous stasis in the hemorrhoidal circulation and participate in the onset or spread of thrombotic processes.

Acute Disease↗
PubMed1994

[Ambulatory treatment of hemorrhoids].

We present a study on 110 patients who were operated of hemorrhoids, on ambulatory basis using the elastic rubber-band ligation. Twenty-six of this patients had degree I hemorrhoids, 54 degrees II and 30 degrees III hemorrhoids. In 19 patients, only one hemorrhoidal mass was bound by session, 84 patients had two masses bound and 17 patients three or more masses. During the postoperative course 76% of the patients had a sensation of incomplete evacuation, but only a 7% of all needed analgesia. About 79% of the patients thought that they had received an excellent treatment. We conclude that this is a very simple technique, allowing excellent results with few complications.

Adult↗
PubMed1994

Double-blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute hemorrhoids.

One hundred patients with a history of hemorrhoidal disease and suffering from an acute hemorrhoidal attack were randomized into two parallel groups and treated with Daflon 500 mg* (D500) or placebo (PL) under double-blind conditions. Daflon 500 mg was administered at the dosage of three tablets bid the first four days and two tablets bid the following three days. Overall improvement of symptoms was greater in the D500 group than in the PL group, from D2 up to D7. The clinical severity of proctorrhagia, anal discomfort, pain, and anal discharge diminished in both groups but to a greater extent in the D500 group (P < 0.001 for all parameters except protorrhagia, P = 0.006). Inflammation, congestion, edema, and prolapse were more markedly improved in the D500 group than in the PL group. Duration and severity of the current hemorrhoidal episode, as assessed by patient self-evaluation, were less important in the D500 group as compared with previous episodes. Use of analgesics and topical medications diminished in both groups, with a major reduction in the D500 group from D4 (P < 0.001). Acceptability was good in both groups: no patient experienced major side effects. In summary, treatment with D500 resulted in a quicker and more pronounced relief of signs and symptoms of acute hemorrhoids than with the placebo.

Acute Disease↗
PubMedDate not supplied

[Effectiveness and innocuousness of the association of calcium dobesilate, dexamethasone acetate and lidocaine versus prednisolone capronate with dibucaine clorohydrate in the treatment of hemorrhoids-].

The objective of the present study was to compare properties of two associations in the topical treatment of hemorrhoids. They were included 40 patient with diagnosis of internal hemorrhoids grade 1 or 2, which was indicated topic treatment after the realization of an interrogatory and anoscopy. The treatment received according to a randomized and double blind design: A = dobesilate of calcium with acetato of dexamethasone and lidocaine or B = Capronato of Prednisolone with Clorhidrato of dibucaina, applied twice a day. They were carried out controls every 7 days. In each control was carried out interrogatory and respective anoscopy. There was a prevalence of the females, and the age corresponded to the 5t decade of the life. Patients of the treatment. A presented greater number of predisponents factors, but minor percentage of previous treatments. As for the evaluation of the punctuation of symptoms and of the grade of Hemorrhoids, comparing beginning and final, they didn't show significant difference interproduct confirming the effectiveness and similar inocuity. In both products was observed a important improvement concerning to the symptoms and grade of hemorrhoids but the patients of the treatment A precipitated the greater speed. As for the evaluation made by the phisicians, the treatment A (88%) and B (85.7%) the got successful outputs. The opinion of the patients was a 100% of marked goods or moderated beneficial. Both treatments were successful so much in effectiveness like in inocuity although the treatment A were always got the best efectiveness outputs.

Administration, Topical↗
PubMedDate not supplied

[The prevention of hemorrhoids in sailors].

Seafaring personnel are exposed in their everyday life and work to factors of ship environment contributing to the development of hypomotor intestinal dyskinesias, colitis, proctitis, proctosigmoiditis, hemorrhoids. Rations for seafaring personnel are deficient in food fibre: 11 g per twenty-four hours, with the norm being 40-70 g per twenty-four hours. A positive result was achieved in the study of the action of a concentrate of food fibre prepared from wheat bran by special methods in patients with hemorrhoids. The above concentrate can be recommended for prevention and dietotherapy of hemorrhoidal disorders of the intestine and hemorrhoids.

Chronic Disease↗
PubMedDate not supplied

[Ambulatory treatment of hemorrhoidal pathology with elastic bands according to a modified Barron technique].

The authors report their experience in the treatment of hemorrhoids by rubber band ligation according to Barron's modified technique which foresees that the ligation is performed thanks to the suction of the hemorrhoidal node through the shaft of the band applicator connected with an aspirator. Eighty-four patients underwent consecutively this treatment over a 18-month period; all were performed with a minimum follow-up of 6 months. Forty male patients (mean age 46.6 years) showed symptoms lasting since 9 years. Forty-four female patients (mean age 42.6 years) showed such pathology since 8.9 years. 70.2% of the patients were classified as III stage of disease, 19% II stage and 10.7% I stage. Thirty-four patients had anal pain, 49 bleeding, 5 anemia, 21 thrombosis of the hemorrhoidal plexus, 54 prolapse of the ano-rectal mucosa. These symptoms and signs were present in most of the patients contemporaneously. Three patients had previously received rubber band ligations, 4 hemorrhoidectomy, 1 sclerotherapy and 1 rubber band ligation and sclerotherapy. In the whole we performed 285 sessions and 304 rubber band ligations. Each treatment consisted of 3.4 sessions and 3.6 rubber band ligations. Recovery was achieved with only one session in 9 patients; 66.7% of them showed 1st degree disease. Multiple sessions were necessary in patients with advanced disease degree; 100% at stage II and 94.9% at stage III. Sixty-five patients did not refer immediate and long-term significant complications. The remaining patients complained during the first hours about heavy feeling and/or tenesmus and two, 2 weeks after the end of treatment, showed bleeding episodes, which cleared up spontaneously. In 5 cases it was necessary, during follow-up, to carry out a completion rubber band ligation and in 3 we performed trimming surgery at the out-patients' department by resection of the exceeding skin and anal mucosa. The technique enables to achieve results just as valid as those of traditional methods in the treatment of hemorrhoidal pathology with the advantage that it can be performed in an out-patient's department, it does not need local anesthesia, it enables the patient to immediately return to his normal working activity and, restricted to the observation period (6- and 12-month follow-up) it allows a satisfactory control of the disease.

Adult↗
PubMedDate not supplied

Circular hemorrhoidectomy in advanced hemorrhoidal disease.

BACKGROUND/AIMS: Milligan-Morgan's hemorrhoidectomy has a high recurrence rate (> 10%) in patients with circular IV grade hemorrhoids. In such cases a circular hemorrhoidectomy with complete elimination of residual piles, and anoplasty might be more successful. The aim of this retrospective study was to compare the results of circular hemorrhoidectomy using the Hopital Leopold Bellan (HLB) technique (Paris) with the reported results of other techniques in patients with advanced hemorrhoidal disease. METHODOLOGY: From January 87 to December 96, 100 consecutive patients with circular IV grade hemorrhoids underwent radical hemorrhoidectomy. Mean hospital stay was 4 days (range 3-7). Patients were strictly controlled in the postoperative period and in cases of early fibrosis anal dilators were used. RESULTS: Eighty one percent of patients had a complete recovery. The recurrence rate was 4%. The cumulative rate of early and late complications was 34%. Early and late hemorrhages were more frequent than in traditional hemorrhoidectomy, while the incidence of anal stenosis was the same. CONCLUSIONS: The HLB operation is the best choice for patients with advanced circular hemorrhoids because of its radicality and good results. The postoperative morbidity of HLB hemorrhoidectomy is higher than traditional hemorrhoidectomy; nevertheless, all complications are tractable without extension of hospital stay.

Adult↗
PubMed1998

[Is there a correlation between dietary habits and hemorrhoidal disease?].

OBJECTIVES: It is empirically accepted that certain foods play a role in the pathogenesis of hemorrhoids or their acute exacerbation. The aim of this work was to determine whether there is a relationship between hemorrhoids and certain food-related or common toxin-related factors. PATIENTS AND METHODS: Two groups of 50 subjects were compared. Group I was composed of 50 patients with hemorrhoid symptoms. Fifty volunteers with no proctologic abnormality were included in group II. We used a diet survey to compare total calorie, protein, carbohydrate, fat, food fiber, water, alcohol, salt, pepper, pimento, tea, and coffee intake was well as smoking habits. Episodes of constipation were also noted. RESULTS: Overall calorie intake, as well as protein, carbohydrate and fiber intake were similar in the two groups as were use of salt, coffee and tea. Dietary intake in group I was higher for fat (p = 0.02), alcohol (p = 0.01), pepper (p = 0.04, and pimento (p = 0.001). Subjects in group I drank less water (p = 0.008), smoked more (p = 0.01) and were more often constipated (p < 0.001) than those in group II. CONCLUSION: Our findings provide further arguments suggesting that dietary imbalance or smoking could be involved in the development of hemorrhoids. These factors should be evaluated in appropriate dietary inquiries. Epidemiological surveys would be required to confirm their possible causal effect.

Alcohol Drinking↗