![]() ![]() ![]() This article deals with some fundamental knowledge and current treatment of uncomplicated and complicated hemorrhoids in a view of a coloproctologist.ĬONTEMPORARY PATHOPHYSIOLOGY OF HEMORRHOIDS Surgery is indicated for high-graded hemorrhoids, or when non-operative approaches have failed, or complications have occurred. Practically, most patients with low-graded hemorrhoids can be effectively treated with non-operative measures by either primary care physician, gastroenterologist or general surgeon in an outpatient setting. Clinicians should therefore advise and treat patients with hemorrhoids with evidence-based medicine and the standard of care. Unfortunately, the quality of information about hemorrhoids treatment on the internet was greatly variable and almost 50% of websites were of poor quality. According to the Google’s annual roundup in 2012 (Google Zeitgeist), hemorrhoids was the top trending heath issue in the United State, ahead of gastroesophageal reflux disease and sexually transmitted disease. People with hemorrhoids, and those wrongly thought to have hemorrhoids, had a tendency to use self-medication rather than to seek proper medical attention. It has been estimated that 25% of British people and 75% of American citizens will experience hemorrhoids at some time in their lives, especially in pregnant women and elderly adults. In 1990, an epidemiologic study of hemorrhoids in the United State revealed a prevalence rate of 4.4%, whereas some reports in the 21 st century from South Korea and Austria yielded a prevalence of hemorrhoids in adult population of 14.4% and 38.9%, respectively. The true prevalence of hemorrhoids is unknown however, recent evidence has suggested an increasing prevalence of hemorrhoids over time. Hemorrhoids is a very common anorectal disease defined as the symptomatic enlargement and/or distal displacement of anal cushions, which are prominences of anal mucosa formed by loose connective tissue, smooth muscle, arterial and venous vessels. Future perspectives in the treatment of hemorrhoids are also discussed. This article deals with some fundamental knowledge and current treatment of hemorrhoids in a view of a coloproctologist - which includes the management of hemorrhoids in complicated situations such as hemorrhoids in pregnancy, hemorrhoids in immunocompromised patients, hemorrhoids in patients with cirrhosis or portal hypertension, hemorrhoids in patients having antithrombotic agents, and acutely thrombosed or strangulated hemorrhoids. ![]() Although excisional hemorrhoidectomy remains the mainstay operation for advanced hemorrhoids and complicated hemorrhoids, several minimally invasive operations (including Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation and stapled hemorrhoidopexy) have been introduced into surgical practices in order to avoid post-hemorrhiodectomy pain. Surgery is indicated for high-graded internal hemorrhoids, or when non-operative approaches have failed, or complications have occurred. Meanwhile, low-graded internal hemorrhoids can be effectively treated with medication and non-operative measures (such as rubber band ligation and injection sclerotherapy). External hemorrhoid usually requires no specific treatment unless it becomes acutely thrombosed or causes patients discomfort. Generally, hemorrhoids can be divided into two types: internal hemorrhoid and external hemorrhoid. It is clinically characterized by painless rectal bleeding during defecation with or without prolapsing anal tissue. Hemorrhoids is recognized as one of the most common medical conditions in general population.
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