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PubMed2000

Treatment of acute strangulated internal hemorrhoids by topical application of isosorbide dinitrate ointment.

Exogenous nitric oxide has been shown useful in decreasing the internal anal sphincter tone. This study investigated the role of isosorbide dinitrate in the treatment of patients with acute strangulated internal hemorrhoids, thereby avoiding the risk of continence disturbances following conventional surgical treatment. Four male patients (median age 35 years, range 30-42) with acute strangulated hemorrhoids were treated with 1% isosorbide dinitrate. The ointment was applied to the anoderm. This application was repeated every 3 h during daytime for 2 weeks. Significant pain relief was achieved within 1 day, while transient mild headache was experienced during the first 2 days. Within 1 week the hemorrhoids became reducible. Thereafter the hemorrhoids could be treated adequately by rubber band ligation. The alternative treatment of patients with acute strangulation of prolapsed internal hemorrhoids is effective. This nonsurgical, i.e., reversible reduction of sphincter tone is an attractive alternative.

Acute Disease↗
PubMed2005

Hemorrhoids and rectal internal mucosal prolapse: one or two conditions? A national survey.

The surgical modalities for the treatment of hemorrhoids are quite numerous due to the rapid diffusion of new surgical techniques and to the different approaches to the pathophysiology of the disease by the proctologists. Stapled hemorrhoidopexy, one of the most recent surgical options proposed, emphasizes the role of rectal internal mucosal prolapse (RIMP) as the main cause of the disease. We performed a national survey among the most important proctologists on this particular clinical condition, in order to better define the indications for the surgical treatment of hemorrhoids. A questionnaire concerning the main clinical features of RIMP was mailed to 84 coloproctology centers. Two-thirds of the 41 proctologists who responded found RIMP in a minority of patients with hemorrhoids, whereas only one-third found RIMP in more than half of their patients. A circumferential RIMP was identified by only 10% of the surgeons, whereas a coincidence between pre- and postoperative diagnoses of this condition was possible in half of proctologists' patients. RIMP is not frequently associated with hemorrhoids. Therefore, it is unlikely to be a cause of hemorrhoidal disease, and many surgeons still recognize it as a difficult clinical condition to define.

Attitude of Health Personnel↗
PubMed2006

Early results of the treatment of internal hemorrhoid disease by infrared coagulation and elastic banding: a prospective randomized cross-over trial.

BACKGROUND: Rubber band ligation (RBL) is probably the most commonly performed nonsurgical therapy for hemorrhoidal disease. Infrared coagulation (IRC) is one of the most recent advances based on the use of "heat". Recent studies have demonstrated similar efficacy for both modalities. This prospective randomized crossover trial compared IRC and RBL for pain, complications, effectiveness, and patient satisfaction and preference in the treatment of internal hemorrhoids (IH). METHODS: Patients were randomized to receive either RBL (Group A) or IRC (Group B) for treatment of the first hemorrhoid; in a second procedure two weeks later, patients underwent the other procedure on the second hemorrhoid, thereby serving as their own control. The procedure preferred by the patient was employed two weeks later for the third hemorrhoid. Post-treatment pain was evaluated on a visual analog scale and on the basis of the percentage of patients requiring analgesics. Bleeding and early outcome of treatment were also recorded, together with the patient's satisfaction. RESULTS: A total of 94 patients were included in this study (47 patients in each group). At 30 minutes and 6 hours after treatment, pain scores were significantly higher in patients treated with RBL than in those treated with IRC (p<0.01). There was no significant difference in pain scores between the two procedures immediately and 24 hours after the procedures (p<0.05). After 72 hours and one week, the pain scores for RBL and IRC were similar. The percentage of patients using analgesics was significantly higher in RBL group than in IRC group at 6 hours (29.6% vs. 19.2%, respectively; p<0.05) and 24 hours (22.5% vs. 13.5%, respectively; p<0.05) after treatment. However, significant differences were not noted at 72 hours (12.7% vs. 6.4%; p<0.05) and one week (5.6% vs. 7.1%; p>0.05) after the procedures. There were significantly higher incidences of bleeding immediately, 6 hours, and 24 hours after RBL compared to IRC (immediate: 32.4% vs. 4.3%; 6 hours: 13.4% vs. 3.6%, 24 hours: 26.8% vs. 10.2%, respectively; p<0.01). However, there were no significant differences noted regarding the incidence of bleeding between the two groups at 72 hours. Complications were more likely after RBL than IRC, however this difference was not significant (p>0.05). Overall, 91 patients (96.8%) were successfully treated and 93 patients (99%) were very satisfied with the treatment. In the third treatment session, 50% of patients selected RBL and 50% chose IRC. CONCLUSIONS: Both RBL and IRC were well-accepted and highly efficacious methods for the treatment of IH; in addition, both procedures were associated with relatively minor complications. However, RBL was associated with more pain than IRC in the 24-hour postoperative period.

Adult↗
PubMed1984

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. Treatment of hemorrhoids: report of a technique.

A technique for the treatment of hemorrhoids has been presented. It is based on a recent study in which the persistence of the anorectal band, a remnant of the anorectal sinus, and failure of rectal neck remodeling are considered responsible for the initiation of the hemorrhoid disease. The constricting effect of the anorectal band on the rectal neck results in elevation of its pressure, straining at defecation, and prolapse of the rectal mucosa. There were 502 patients with third and fourth degree hemorrhoids. The preoperative rectal neck pressure was high in all of them. The technique comprises division of the anorectal band and hemorrhoid ligation. The results were satisfactory, and the complications were negligible. The rectal neck pressure was normalized and straining disappeared. The procedure is simple and easy. Compared with the other techniques for hemorrhoid treatment, it offers the advantage of dealing with the primary etiologic factor.

Adult↗
PubMed1981

Urethral discharge, constipation, and hemorrhoids. New syndrome with report of 7 cases.

A new syndrome in which 7 cases share common clinical features of urethral discharge only at defecation, constipation, and hemorrhoids is reported. The discharge occurred only with constipation. The relationship between urethral discharge, constipation, and hemorrhoids is discussed. The concept that hemorrhoids lead to prostatic venous congestion is put forward. The urethral discharge at defecation seems to be the result of "milking" of the congested prostate by the hard stools. The mechanism of fecal and urinary "milking" of the prostate is discussed. The role of the congested prostate in infertilogenesis is presented. It seems that metabolic accumulation in the prostatic, vesicular, and ampullary secretions affected the spermatogenic activity as it similarly does in varicocele. Permanent disappearance of urethral discharge and improvement of semen quality were achieved on anoprostatic decongestion by medical treatment, hemorrhoid injection, or hemorrhoidectomy. The syndrome of prostatorrhea, constipation, and hemorrhoids should be considered in patients with idiopathic urethral discharge and in infertile patients.

Adult↗
PubMed2004

Retroflexed endoscopic multiple band ligation of symptomatic internal hemorrhoids.

BACKGROUND: Elastic band ligation is a well-established nonoperative method for treatment of internal hemorrhoids that give rise to symptoms. This study assessed the efficacy and safety of retroflexed endoscopic multiple band ligation, a procedure that involves extensive ligation of internal hemorrhoids, and the immediately proximal normal rectal mucosa, by means of a retroflexed endoscope. METHODS: Eighty-two patients with symptoms caused by internal hemorrhoids (15, stage I; 19, stage II; 47, stage III; 1, stage IV) were treated by retroflexed endoscopic multiple band ligation. Symptoms (prolapse, bleeding, pain with defecation) were graded from 0 to 3. Range and form of the internal hemorrhoids were evaluated endoscopically. Retroflexed endoscopic multiple band ligation was performed by using a flexible endoscope with an attached band ligation device in the retroflexed position. RESULTS: A mean of 8 bands (range 4-14) were placed per treatment session. Seventy-six patients were treated in a single session, 5 in two sessions, and one in 3 sessions. Symptom and endoscopic scores improved at 4 weeks after the retroflexed endoscopic multiple band ligation: bleeding, from 1.26 to 0.53 (p<0.01); prolapse, from 1.94 to 0.5 (p<0.01); pain, from 1.03 to 0.93 (p=0.67); Goligher classification, from 2.41 to 1.09 (p<0.01); range, from 3.25 to 0.56 (p<0.01); and form, from 2.81 to 0.56 (p<0.01). Long-term response (mean follow-up 12 months, range 3-40 months) was excellent for 89% of the patients, good for 9%, and poor for 2%. No major complication was noted. CONCLUSIONS: Retroflexed endoscopic multiple band ligation is a safe and effective method for treatment for patients with symptoms caused by internal hemorrhoids.

Adult↗
PubMed1997

Resolution of chronic anal fissures after treatment of contiguous internal hemorrhoids with direct current probe.

BACKGROUND PURPOSES: (1) to prospectively evaluate efficacy and safety of direct current (DC) probe treatment of chronic anal fissures associated with internal hemorrhoids, and (2) to estimate direct and indirect costs of anoscopic treatment versus surgery. METHODS: Ten patients with chronic fissures of 11 mm (mean length) had symptoms for 5 months (mean) in spite of medical management; all had internal hemorrhoidal disease. DC coagulation was applied to two or three contiguous internal hemorrhoids per outpatient session. Eleven mA (mean) of DC current was delivered for 7 minutes (mean) per hemorrhoid segment. RESULTS: All 10 patients had relief of chronic anal pain within two treatments and nine anal fissures healed within 4 weeks. One patient developed a perianal abscess and fistula requiring surgery. There were no recurrences in 20 months (mean) of follow-up with medical management. Mean direct and indirect costs (in terms of lost time from work or usual activity) of DC probe treatments were estimated to be 10% to 30% lower and 2 to 10 times less, respectively, than standard surgery for chronic anal fissures. CONCLUSION: DC probe treatment for chronic anal fissures associated with internal hemorrhoidal disease is an important advance as an effective, safe, and cost-effective nonsurgical treatment in selected patients.

Adolescent↗
PubMed1978

Modern management of hemorrhoids.

Hemorrhoids require therapy only when they cause symptoms. Early symptoms troubling the patient only occasionally are readily managed by dietary measures that increase the intake of fluids and fiber, such as bran, often supplemented by hydrophilic bulk-forming colloids, so that a bulky, soft stool is produced regularly. Rubber band ligation is the treatment of choice for small or moderate sized hemorrhoids with minimal prolapse, whether or not they bleed. Such bands should be applied to the mucosa at the anorectal junction and not directly to the hemorrhoidal tissue. Patients with large prolapsing or acutely thrombosed hemorrhoids are best managed by a closed type of hemorrhoidectomy. This technique is effective and safe and has great advantage with rapid healing and minimal postoperative care, which provides the patient with the maximum comfort. Complications are few and, in particular, anal stenosis or stricture is rare. Hemorrhoids occurring in association with other conditions require specific treatment only if they are responsible for symptoms in their own right, distinct from the associated condition. Other treatments discussed are effective but have particular disadvantages that make them unsuitable for routine use. Moreover, they offer no advances on the treatment regimens proposed.

Anal Canal↗
PubMedDate not supplied

Recurrent epistaxis from Kiesselbach area syndrome in patients suffering from hemorrhoids: fact or fiction?

BACKGROUND: It has been found that >90% of patients suffering from recurrent epistaxis from Kiesselbach area syndrome (REKAS) simultaneously suffered from hemorrhoids. To clarify this, the authors decided to investigate in the opposite direction, i.e., to find out whether or not REKAS occurs in patients suffering primarily from hemorrhoids. METHODS: The study group included 53 randomly selected hospitalized patients with hemorrhoidal disorder (31 males and 22 females: age range 18-57 years). A search for essential clinical signs of REKAS was performed in each patient. RESULTS: Incidence was not high, although all clinical parameters were nearly the same: dilated vessels in Kiesselbach venous plexus (83.01%) and a positive hereditary factor (92.7%). The only missing factor in patients with hemorrhoids was anterior septal deformity, so frequent in REKAS patients. CONCLUSIONS; The authors conclude that REKAS and hemorrhoidal syndrome are separate clinical entities that are characterized by dilated vessels of similar venous plexus and simultaneous appearance in the same patient or close relatives.

Adolescent↗
PubMed2003

Multiple hemorrhoidal ligation: a prospective, randomized trial evaluating a new technique.

PURPOSE: A modified anoscope was developed, with lateral apertures at the left lateral, right anterior, and right posterior quadrants, to enable synchronous exposure and ligation of all three internal hemorrhoids. Results were compared with those for conventional multiple ligation. METHODS: Postligation pain, complications, and outcomes were compared between synchronous ligation with the new anoscope (synchronous group) and three-quadrant ligation with a conventional anoscope with similar overall dimensions (conventional group). RESULTS: Twenty-five patients were prospectively randomized to each group. Postligation pain and analgesic requirements were recorded up to 28 days, and postligation complications and outcomes were evaluated for a minimum of 6 months. Narcotic requirements were lower in the synchronous group, but this difference did not achieve statistical significance (P > 0.05, Student's t-test). Secondary hemorrhage occurred in 1 patient (4 percent) in the conventional group but resolved spontaneously. The synchronous group experienced significantly less pain during the ligation procedure and for 2 days afterward (P < 0.01, Wilcoxon's test). External hemorrhoidal thrombosis developed in 4 percent of the synchronous group and 12 percent of conventionally treated patients, all of whom responded to conservative treatment. Repeat ligation was required less often in the synchronous group (16 percent) than with conventional ligation (28 percent). Surgery (completion hemorrhoidectomy for external thrombosis) was necessary in one patient (4 percent) in each group. Anal stenosis developed in one patient in the synchronous group. CONCLUSION: The new anoscope provides improved exposure of all three internal hemorrhoids and permits optimal placement of the rubber bands; this may account for the decreased postligation pain and lower repeat ligation rates. Synchronous hemorrhoidal ligation is a less painful method of multiple hemorrhoidal ligation and may improve outcomes compared with conventional multiple ligation.

Analgesics↗
PubMed2000

Hemorrhoid banding using videoendoscopic anoscopy and a single-handed ligator: an effective, inexpensive alternative to endoscopic band ligation.

OBJECTIVE: We evaluated a technique of hemorrhoid banding using videoscopic anoscopy and a single-handed ligator that offers substantial cost savings over endoscope-mounted devices. METHODS: Patients with rectal bleeding from grade II/III hemorrhoids had videoscopic anoscopy, which provided a magnified view, allowing accurate localization of the hemorrhoids and the dentate line before banding, and a photographic record, if required. Banding was performed using a suction ligator that could be operated by one hand, allowing the other to control the anoscope. RESULTS: Of 39 patients with second- and third-degree hemorrhoids, 34 (87%) had no further bleeding after a single banding session and a further three had no recurrence after a second session. The only complications were pain (one patient) and infection (one patient). CONCLUSIONS: This method is convenient and effective, costing per procedure less than one-tenth of endoscope-mounted band ligators. We recommend its use in preference if magnified views and a photographic record are required. However, its cost and complexity, compared with traditional hemorrhoid banding, may mean that the latter is preferred in the office setting.

Adult↗
PubMed2000

Rubber band ligation of symptomatic internal hemorrhoids: results of 500 cases.

BACKGROUND/AIM: In this prospective study the results of rubber band ligation (RBL) of symptomatic hemorrhoids in 500 consecutive patients with 2nd (255 cases), 3rd (218 cases) and 4th degree (27 cases) hemorrhoids are presented. METHODS: The patients' symptoms were hemorrhage in 142 cases (28.4%), prolapse in 33 cases (6.6%) and both hemorrhage and prolapse in 325 cases (65%). Sixteen patients with hemorrhoids had liver cirrhosis and portal hypertension. RBL was performed using the St Marks' applicator (Seward) on an outpatient basis. Multiple ligations in two (259 cases) or three (190 cases) sessions were undertaken in 449 patients (89.8%), while a single ligation was done in 51 cases (10.2%). RESULTS: Successful results were achieved in 440 cases (88%) in a 24-month follow-up. A total of 94 patients (18.8%) had complications which required no hospitalization. Pain and hemorrhage were the most frequent complications. RBL proved to be safe in 16 patients with coagulation disorders due to liver cirrhosis. Two years after RBL, symptomatic recurrence was 11.9% (53/445) with repeat RBL or surgery in 9.2% (41/445). CONCLUSIONS: RBL is a useful, safe and successful method for treating symptomatic 2nd and 3rd degree hemorrhoids, which can be applied successfully in selected cases with 4th degree hemorrhoids, but with an increased rate of recurrence and additional treatment requirements. Also, RBL seems to be safe in patients with liver cirrhosis and portal hypertension.

Female↗
PubMed1998

Hemorrhoids.

The patients with routine, easiest-to-treat hemorrhoids average 1.25 office visits, 0.80 prescriptions, and 1.38 medical/surgical procedures during the course of a year. About 63.9% of all PTEs were treated without the use of prescription drugs. This patient group did not receive any hospital admissions or professional inpatient services. Hemorrhoid surgery was performed at an average rate of 1.37 times per PTE on an out-patient basis. Seventy-two percent of the overall medical charges for hemorrhoid treatment are direct surgical charges. Of the PTEs treated with a single drug group, only 1.5% are treated with a prescription laxative. However, the use of OTC stool softeners and laxatives were not measured in this analysis. Thus, an exact measurement of cost savings associated with appropriate use of softeners/laxatives for the prevention of recurrent hemorrhoids could not be determined. Considering the potential cost savings of using laxatives for prevention of hemorrhoids, further investigation of the prescribing patterns of this specialty may prove useful.

Adolescent↗
PubMed2000

Khat induced hemorrhoidal disease in Yemen.

OBJECTIVE: The aim of this study was to evaluate the potential association between the habit of khat chewing and the development of hemorrhoidal disease METHODS: Four hundred and seventy four individuals (373 men and 101 women) with ages ranging from 17 to 80 years were divided into 2 groups. Group 1 (n=247) chronic khat chewers. Group 2 (n=200) non-khat chewers. Data was collected regarding chewing habits, colorectal symptoms, abdominal, proctoscopic, and operative findings. RESULTS: The key difference between the 2 groups was the incidence of hemorrhoids and hemorrhoidectomy. In the chronic khat chewers group: 169 (62%) had hemorrhoids. Of these 124 (45.4%) underwent hemorrhoidectomy. In the control group there is 8 (4%) had hemorrhoids and one patient underwent hemorrhoidectomy (0.5%). P-value (0.05). CONCLUSION: The study demonstrated a significant association between the habit of khat chewing and the development of hemorrhoidal disease.

Adolescent↗
PubMed2002

Hemorrhoidectomy for thrombosed external hemorrhoids.

External hemorrhoids represent distended vascular tissue in the anal canal distal to the dentate line. Persons with thrombosed external hemorrhoids usually present with pain on standing, sitting or defecating. Acutely tender, thrombosed external hemorrhoids can be surgically removed if encountered within the first 72 hours after onset. Hemorrhoidectomy is performed through an elliptic incision over the site of thrombosis with removal of the entire diseased hemorrhoidal plexus in one piece. Caution must be exercised to avoid cutting into the muscle sphincter below the hemorrhoidal vessels. Infection after suture closure is rare secondary to the rich vascular network in the anal area. Stool softeners must be prescribed postoperatively to help prevent tearing at the suture line. Training and experience in general and skin surgery are necessary before the physician attempts this procedure unsupervised.

Anal Canal↗
PubMed2002

Efficacy of Daflon in the treatment of hemorrhoids.

OBJECTIVE: To demonstrate the value of Daflon in the management of hemorrhoidal symptoms in Saudi patients attending the Surgical clinic. METHODS: This is a prospective clinical study of 105 consecutive patients suffering from hemorrhoidal problems including thrombosed piles. Detailed history and proctoscopic examination to determine position, size, and degree of hemorrhoids was conducted in all patients attending the Surgical Clinic at Dammam Central Hospital, Dammam, Kingdom of Saudi Arabia (KSA). The study was conducted over a 6-months period (December 2000 to May 2001). All were started on Daflon; 2 tablets twice daily for 4 weeks and were followed up weekly during the study period and proctoscopic examination was conducted at each consultation. RESULTS: The mean age was 35 (range 19-70) years. The majority (77%) suffered congested hemorrhoidal disease and only 8% had thrombosed piles. Previous surgery for piles was noted in 11%. Concomitant medical diseases were present in 10%. The degrees of piles were first degree (23 patients), 2nd degree (73), 3rd degree (9) and 4th degree (0). There was a statistically significant (p<0.001) improvement in pain, heaviness, bleeding, pruritus, and mucosal discharge from baseline to last visit. There was also a significant (p<0.001) improvement on the proctoscopic appearance. Five patients failed to improve on Daflon; therefore, they underwent surgery. The side effects of Daflon (mainly gastrointestinal symptoms) were encountered in 5 patients but did not force interruption of the medication. CONCLUSION: Daflon is a very safe and effective drug in the treatment of all hemorrhoidal symptoms in the population of Eastern KSA.

Adult↗
PubMed2004

Symptomatic hemorrhoids.

The most important aspect in the diagnosis of hemorrhoidal disease is the exclusion of other, more life-threatening conditions. Hemorrhoidal banding remains the most successful method to manage hemorrhoids in the outpatient clinic. Chronic application of local medications to the perineum may result in dermatologic conditions. It is safe to manage acutely inflamed hemorrhoids surgically. Table 1 is a summary of the various methods for the surgical management of symptomatic prolapsing hemorrhoids. Dietary manipulation, including fiber supplementation, should always accompany surgical

Ambulatory Surgical Procedures↗
PubMed2005

Ambulatory hemorrhoid therapy with radiofrequency coagulation. Clinical practice paper.

BACKGROUND: Despite availability of numerous surgical and non-surgical options for the treatment of hemorrhoids like sclerotherapy, rubber band ligation, cryosurgery, infrared photocoagulation, bipolar diathermy, and electro coagulation, none of these therapies has been acclaimed as the ultimate. Coagulation of hemorrhoids using a radio-frequency device is a new therapy to be added to the list. PATIENTS AND METHODS: In the present retrospective study, the early and long -term effects of radiofrequency coagulation on patients presenting with hemorrhoids is described. An Ellman radiofrequency generator was used for this procedure. In a separate, randomized, and blinded study, a comparative evaluation was carried out between radiofrequency coagulation and rubber band ligation in terms of their effectiveness and patient comfort. RESULTS: Two hundred and forty patients with Grade I and II hemorrhoids were treated by radiofrequency coagulation technique and were followed up for a period of 16 months. While 33 patients reported persistence or recurrence of bleeding, only few complained of pain or discomfort. The comparative study showed that though rubber band ligation is an effective procedure, its pain quotient is greater than the radiofrequency coagulation. CONCLUSION: This study shows that radiofrequency coagulation is an easy and effective alternative to conventional techniques employed in the treatment of bleeding hemorrhoids. It is easy to perform, is less painful, and has a low rate of complications. However, further results based on a longer follow-up of larger number of patients and its comparison with other conventional treatment techniques are called for.

Adult↗