Hemorrhoids management

Hemorrhoids management

Hemorrhoidal disease results from enlargement or thrombosis of veins within the internal or external hemorrhoidal plexus.

Clinical presentation

• Painless anorectal swelling (piles)

• Painless bleeding, typically occurring after defecation

• Pain

• Pruritus ani

• Prolapse of hemorrhoidal tissue

Investigations

Endoscopic evaluation

• Anoscopy

• Proctoscopy or proctosigmoidoscopy

These examinations may demonstrate characteristic internal or external hemorrhoids and help exclude other anorectal pathology.

Treatment

Management depends on the severity and grade of hemorrhoidal disease.

Grade I hemorrhoids

Managed conservatively with:

• Medical therapy

• Avoidance of non-steroidal anti-inflammatory drugs (NSAIDs) where possible

• Avoidance of spicy and fatty foods

• Dietary and lifestyle modification

Grade II and Grade III hemorrhoids

Initially treated with non-surgical procedures such as:

• Sclerotherapy

• Rubber band ligation

Grade III and Grade IV hemorrhoids

Patients with very symptomatic Grade III hemorrhoids and most Grade IV hemorrhoids are best managed with:

• Surgical hemorrhoidectomy

Pharmacological treatment

Rectal suppository therapy

Benzyl benzoate 1.25% + bismuth oxide 0.875% + bismuth subgallate 2.25% + hydrocortisone acetate 0.25% + Peru balsam 1.875% + zinc oxide 10.75%

• Suppository (PR) once or twice daily

OR

Oral therapy

Euphorbia prostrata extract 100 mg + calcium dobesilate 500 mg

• (PO) 24 hourly

• Chewable preparation; do not swallow whole

AND

Corticosteroid/anesthetic suppository

Prednisolone hexanoate 1.3 mg + cinchocaine hydrochloride 1 mg

• Suppository (PR) 24 hourly for 5–7 days