Practice Parameters for the Management of Hemorrhoids (Revised)

Cataldo, Peter A.; Ellis, C. Neal; Gregorcyk, Sharon G.; Hyman, Neil; Buie, W. Donald; Church, James M.; Cohen, Jeffrey; Fleshner, Phillip; Kilkenny, John; Ko, Clifford Y.; Levien, David H.; Nelson, Richard L.; Newstead, Graham L.; Orsay, Charles P.; Perry, W. Brian; Rakinic, Jan; Shellito, Paul C.; Strong, Scott A.; Ternent, Charles A.; Tjandra, Joe J.; Whiteford, Mark H.

doi:10.1007/s10350-004-0921-4

Cited by 164 publications

(74 citation statements)

References 36 publications

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“…Patients are instructed to avoid letting their bodies get too cold, and women are encouraged to be especially careful during their menstrual cycles. In terms of food and drink, patients are told to be sure to get enough water, increase the amount of fiber in their diets 57) , and be careful with their alcohol consumption. As to their toilet habits, patients are insturucted to avoid excessive straining and extended time defecating (sitting on the toilet for long periods).…”

Section: ) Everyday Lifestyle Guidancementioning

confidence: 99%

“…Compared to LE, PPH has advantages that include less postoperative pain, less bleeding, shorter hospital stays, and quicker return to normal activities 1,33) . Some reports state that there is no significant difference between the two techniques in terms of recurrence rates 94,98) , but other studies cite higher recurrence rates with PPH after long-term follow-up 57,95,97,99) .…”

Section: ) Pphmentioning

confidence: 99%

“…Among overseas reports and guidelines, there are numerous opinions stating that surgery should be performed within 72 hours of complaints of severe pain [105][106][107][108] . A comparison of retrospective studies shows that recurrence rates with conservative treatment are 25.4% compared with 6.3% for surgical treatment.…”

Section: ) Thrombosed External Hemorrhoidsmentioning

confidence: 99%

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Japanese Practice Guidelines for Anal Disorders I. Hemorrhoids

Yamana

2017

J Anus Rectum Colon

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The pathogenesis of hemorrhoids is a weakening of the anal cushion and spasm of the internal sphincter. Bowel habits and lifestyles can be risk factors for hemorrhoids. The prevalence of hemorrhoids can encompass 4 to 55% of the population. Symptoms include bleeding, pain, prolapsing, swelling, itching, and mucus soiling. The diagnosis of hemorrhoids requires taking a thorough history and conducting an anorectal examination. Goligher's classification, which indicates the degree of prolapsing with internal hemorrhoids, is useful for choosing treatment. Drug therapy for hemorrhoids is typically utilized for bleeding, pain, and swelling. Ligation and excision (LE) is considered for Grade III and IV internal and external hemorrhoids. Rubber band ligation is used to treat up to Grade III internal hemorrhoids. Phenol almond oil is effective for internal hemorrhoids up to Grade III, while aluminum potassium sulfate and tannic acid have shown efficacy in treating prolapsing in internal hemorrhoids at Grades II, III, and IV. Procedure for prolapse and hemorrhoids (PPH) is surgically effective for Grade III internal hemorrhoids; however, the long-term prognosis is not favorable, with high recurrence rates. Separating ligation is effective surgical treatment for internal/external hemorrhoids Grade III and Grade IV. The basic approach to thrombosed external hemorrhoids and incarcerated hemorrhoids is conservative treatment; however, in some acute or severe cases, surgical resection is considered. Comparing the different instruments used for hemorrhoid surgery, all reduce operating time, blood loss, post-operative pain, and length of time until the return to normal activity. They do, of course, increase the cost of the procedure.

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Section: ) Everyday Lifestyle Guidancementioning

confidence: 99%

Section: ) Pphmentioning

confidence: 99%

Section: ) Thrombosed External Hemorrhoidsmentioning

confidence: 99%

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Japanese Practice Guidelines for Anal Disorders I. Hemorrhoids

Yamana

2017

J Anus Rectum Colon

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“…Surgery is indicated in the treatment of combined internal and external hemorrhoids or Grade III and Grade IV hemorrhoids, especially in patients who are unresponsive to other methods of treatment or those with extensive disease [4]. Only surgical remedies allow complete cure and are recommended in the treatment of Grade III and Grade IV symptomatic hemorrhoidal disease [5]. Around 10% to 15% of patients with hemorrhoids eventually require surgical treatment [2].…”

Section: Introductionmentioning

confidence: 99%

Stapled Hemorrhoidectomy; Results of a Prospective Clinical Trial in Saudi Arabia

Guraya

Khairy²

2013

JCDR

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Objectives: This study was designed to evaluate the effectiveness of stapled hemorrhoidectomy (SH) in terms of cure of the symptoms and post-operative pain control. Material and Methods:In this prospective clinical study, SH (Ethicon Endo-surgery, Cincinnati, OH) was performed for all patients with grade III and grade IV hemorrhoids, presenting to the surgical clinics of Ohud and Meeqat Hospitals Almadinah Almunawwarah Saudi Arabia. The results of SH were evaluated by a questionnaire focusing on the relief of symptoms, severity of post operative pain, and complications of SH.Results: Thirty patients (21 males and 9 females); with a mean age of 39.6 years were recruited in this study. Twenty six (86%) patients had grade III and 4 (14%) presented with grade IV hemorrhoids. Perianal prolapse was the most frequent presentation reported in 23 (76%). Mean operating time was 21.7 minutes (range; 17-36 minutes) whereas mean hospital stay was 1.9 days. Post-operative pain was tolerable (nonpersistent) in 28 (93%) cases whereas 2 (7%) experienced mild pain requiring additional analgesia. Urinary retention was the most common complication found in 5 (16%) patients. All patients were cured of the hemorrhoids Conclusion: SH is a safe, rapid, and convenient surgical remedy for grade III and grade IV hemorrhoids with low rate of complications, minimal postoepative pain, and early discharge from the hospital.

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“…13 Trans anal hemorrhoidal arterial ligation (HAL) and repair of anorectal mucosa (RAR) is a newer surgical technique that uses Doppler ultrasound guided identification and suture ligation of the distal rectal arterial branches and simultaneous repair of the prolapsed hemorrhoidal cushions.…”

Section: Introductionmentioning

confidence: 99%

Successful non-surgical management of all degree hemorrhoids

2017

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Background: To evaluate the patients with primary hemorrhoids after employing mainly the non-surgical treatment in all degree hemorrhoids.Methods: A prospective and descriptive study over three hundred and fifty (350) patients in four-year period. Concomitant anal fissure, anal fistula, secondary hemorrhoids, and recurrent hemorrhoids were excluded from the study.Results: Total 350 patients (age range-18-80 years). Female340 (97.14%) and male10 (2.58%) admitted in surgical OPD of three different hospitals during the period of Feb 2013- Jan 2017. All patients were thoroughly examined abdominally and per rectally and proctoscopied as well to rule out concomitant pelvic and perineal pathologies. All proctoscopic findings and treatment were done by single surgeon. Treatment of hemorrhoids was categorized into three types. Type I, conservative (fiber +oral lubricants + in jeer + micronized purified flavonoid fraction + sitz bath), type II, injection sclerotherapy & type III, surgery (open Hemorrhoidectomy). All degree hemorrhoids were first kept on conservative treatment and followed weekly for bleeding and hemorrhoid swelling. Only 38.57% required Injection sclerotherapy in cases where conservative treatment was failed, large hemorrhoid swelling (> 2cm size) seen on first proctoscopy and in cases where frequent fresh bleeding episodes found either on every 2nd-3rd day or every passage of stool. Strangulated bleeding hemorrhoids dealt with anal strapping, conservative treatment and later with injection sclerotherapy, which was given after resolution of bleeding and strangulation. Open hemorrhoidectomy was done in non-compliant and in patients with exclusive external hemorrhoids.Conclusions: Although conservative oral therapy has been given appreciating results but in adjunct with injection sclerotherapy the optimal results were promising.

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Practice Parameters for the Management of Hemorrhoids (Revised)

Cited by 164 publications

References 36 publications

Japanese Practice Guidelines for Anal Disorders I. Hemorrhoids

Japanese Practice Guidelines for Anal Disorders I. Hemorrhoids

Stapled Hemorrhoidectomy; Results of a Prospective Clinical Trial in Saudi Arabia

Successful non-surgical management of all degree hemorrhoids

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