Diagnosis and treatment of haemorrhoids in the elderly: results from 291 patients

Abstract

Haemorrhoids are believed to be rare in elderly patients, occurring mainly in young and middle-aged subjects. Symptoms of haemorrhoids in elderly patients, in addition, require a precise differential diagnosis in order to rule out neoplasia. In this paper we report our experience in dealing with haemorrhoidal disease in 291 patients older than 65 years. Symptoms of presentation were those commonly reported by younger patients. Accurate clinical examination, proctoscopy and flexible sigmoidoscopy allowed reaching a differential diagnosis in the majority of patients. Extensive colorectal diagnostic screening was required in 28.5% of patients due to the clinical presentation. Treatment was conservative in most cases, with 57.2% of the patients treated medically and 36.7% undergoing rubber band ligation (RBL). In this group of patients no complications occurred although several risk factors were present (e.g. anticoagulant medications, diabetes, cardiovascular diseases). A further 13% of the patients underwent surgery with no complications or mortality. Haemorrhoids in elderly patients occur with features similar to those of other ages and ambulatory treatment can be performed. In particular, RBL can be performed safely even in those patients presenting with associated illness.