Management of Hemorrhoids.
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Date
2014-11
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Abstract
This article discusses the pathophysiology, risk factors, classification, clinical evaluation and current nonoperative and operative
treatment of hemorrhoids. Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal
anal cushions. The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement. The abnormal
dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue
within the anal cushion, is a paramount finding of hemorrhoids. It appears that the dysregulation of the vascular tone and
vascular hyperplasia might play an important role in hemorrhoidal development, and could be a potential target for medical
treatment. In most instances, hemorrhoids are treated conservatively, using many methods such as lifestyle modification, fiber
supplement, suppository-delivered anti-inflammatory drugs and administration of venotonic drugs. Nonoperative approaches
include sclerotherapy and, preferably, rubber band ligation. An operation is indicated when nonoperative approaches have
failed or complications have occurred. Several surgical approaches for treating hemorrhoids have been introduced including
hemorrhoidectomy and stapled hemorrhoidopexy, but postoperative pain is invariable. Some of the surgical treatments
potentially cause appreciable morbidity such as anal stricture and incontinence. The applications and outcomes of each treatment
are discussed.
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Keywords
Hemorrhoids, pathophysiology, treatment, management, outcome
Citation
Chugh Anmol, Singh Rajdeep, Agarwal P N. Management of Hemorrhoids. Indian Journal of Clinical Practice. 2014 Nov; 25(6): 577-580.