A small silicone band is placed through a proctoscope well above (about 1cm) the dentate line along the superior aspect of the symptomatic haemorrhoidal columns. It can be an option for some patients with grade 3 haemorrhoids who may want to avoid formal surgery. Rubber band ligation – is the most common office-based procedure used to treat grade 1–2 haemorrhoids. Surgical treatments should be reserved for patients who report regular bleeding, especially with anaemia. 3 There is no evidence to support the use of popular over-the-counter topical corticosteroids, although many patients report subjective improvement. Symptomatic haemorrhoids, especially those in grades 1–2, are usually self-limiting and often respond well to non-invasive treatment: increasing fluid and soluble fibre intake, regular exercise, avoiding straining (can be with constipation or diarrhoea) and spending less time on the toilet.Ī meta-analysis of seven randomised trials showed that fibre supplementation (7–20g per day note that one teaspoon of psyllium husk only contains about 6g of fibre) decreased bleeding symptoms by 50 per cent, but had little effect on prolapse, pain and itching from haemorrhoids. There are two groups of patients with symptomatic haemorrhoids that should be discussed. Treatment of haemorrhoids is highly dependent on symptoms and needs to be carefully balanced with the patient’s comorbidities. If they have any prolapsing disease, they may complain of perianal discomfort or an ache/heaviness, pruritis ani (from mucous soiling) and/or faecal incontinence. Patients typically describe bright red blood (often causing them concern) and often hear the blood dripping into the toilet bowl. The common symptom of haemorrhoids is painless outlet rectal bleeding. Grade 3 – require manual reduction to reduce prolapse Haemorrhoids are clinically classified as follows: They serve in providing continence but become pathological when engorged and, subsequently, symptomatic. Haemorrhoidal columns, also known as “anal cushions”, are normal anatomic clusters of vascular and connective tissue, smooth muscle and overlying mucosa that exist in the left lateral, right anterior and right posterior anal canal (the classic four, seven and 11-o’clock positions). Importantly, colorectal cancer in patients under the age of 50 is predominantly left sided, so digital rectal examination at initial review is crucial. 1,2įurther, any re-presenting patient with increasing symptoms, regardless of age, should be carefully considered for formal colorectal exoneration, and referral to a specialist may assist with that. The risk of malignancy in this age group is approximately 1–3 per cent, with an incidence of polyps of about 15 per cent. All patients with per rectal bleeding over the age of 45–50 should have formal colonic exoneration by either colonoscopy or CT colonography. Serious conditions such as malignancy and inflammatory bowel disease should always be considered, as they may present with similar symptoms, and can also coexist. At Counties Manukau DHB in 2015/16, presumed haemorrhoids accounted for over 90 per cent of referrals to the outpatient colorectal service (own data).Įxternal haemorrhoids is a term commonly used to describe conditions such as perianal haematoma or skin tags, and treatment for these is not the same as described here. They are extremely common in the general population. This article pertains to internal haemorrhoids, which are proximal to the dentate line and have visceral innervation.
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