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Hemorrhoids pp 119-128 | Cite as

The Acute Management of Hemorrhoids

  • Alexander Hardy
Reference work entry
Part of the Coloproctology book series (COLOPROCT, volume 2)

Abstract

Chronic hemorrhoids can cause a number of symptoms, but are rarely painful. There is a tendency to attribute any perianal symptoms to “piles” and patients presenting with acute anal pain may have another underlying pathology. However, the acute complications of hemorrhoids may be debilitating and cause severe pain. This is due to either strangulation of prolapsed internal hemorrhoids or a thrombosed perianal varix – two discrete clinical entities requiring differing approaches to treatment. If symptoms are subsiding, a conservative approach may be adopted with systemic analgesics, stool softeners, and topical treatments. The hemorrhoids can then be reassessed several months later when symptoms have resolved and treated appropriately. Operative intervention may be considered to relieve symptoms if feasible, the expertise is available, and the presentation is early enough. The thrombosed perianal varix can be evacuated or the strangulated hemorrhoids excised. Care must be taken in an emergency hemorrhoidectomy to remove only the affected tissue, avoiding the sphincters and leaving adequate skin bridges. Clinical decisions about treatment should be directed toward the relief of symptoms and not merely the restoration of anatomy.

References

  1. Ackland TH (1961) The treatment of prolapsed gangrenous haemorrhoids. Aust N Z J Surg 30:201–203CrossRefPubMedGoogle Scholar
  2. Allan A, Samad AJ, Mellon A, Marshall T (2006) Prospective randomised study of urgent haemorrhoidectomy compared with non-operative treatment in the management of thrombosed internal haemorrhoids. Color Dis 8(1):41–45CrossRefGoogle Scholar
  3. Brown SR, Ballan K, Ho E, Ho Fams YH, Seow-Choen F (2001) Stapled mucosectomy for acute thrombosed circumferentially prolapsed piles: a prospective randomized comparison with conventional haemorrhoidectomy. Color Dis 3:175–178CrossRefGoogle Scholar
  4. Ceulemans R, Creve U, Van Hee R, Martens C, Wuyts FL (2000) Benefit of emergency haemorrhoidectomy: a comparison with results after elective operations. Eur J Surg 166:808–812CrossRefPubMedGoogle Scholar
  5. Cook TA, Humphreys MM, McC Mortensen NJ (1999) Oral nifedipine reduces resting anal pressure and heals chronic anal fissure. Br J Surg 86:1269–1273CrossRefPubMedGoogle Scholar
  6. Corman ML et al (2003) Stapled haemorrhoidopexy: a consensus position paper by an international working party - indications, contra-indications and technique. Color Dis 5:304–310CrossRefGoogle Scholar
  7. Deen KI (1996) Outpatient treatment of isolated strangulated haemorrhoids with single dose injection sclerotherapy and oral Daflon. Eur J Surg 162:403–405PubMedGoogle Scholar
  8. Eu KW, Seow-Choen F, Goh HS (1994) Comparison of emergency and elective haemorrhoidectomy. Br J Surg 81:308–310CrossRefPubMedGoogle Scholar
  9. Gaj F, Trecca A, Busotti A, Brugiotti C, Carboni M (2002) The new classification of hemorrhoids: PATE 2000-Sorrento. History of the scientific debate. Minerva Chir 57:331–339PubMedGoogle Scholar
  10. Ganchrow MI, Mazier WP, Friend WG, Ferguson JA (1971a) Hemorrhoidectomy revisited – a computer analysis of 2,038 cases. Dis Colon Rectum 14:128–133CrossRefPubMedGoogle Scholar
  11. Ganchrow MI, Bowman HE, Clark JF (1971b) Thrombosed hemorrhoids: a clinicopathologic study. Dis Colon Rectum 14:331–340CrossRefPubMedGoogle Scholar
  12. Giannini I et al (2015) Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute haemorrhoidal disease: a prospective randomised triple-blind controlled trial. Tech Coloproctol 19(6):339–345CrossRefPubMedGoogle Scholar
  13. Gibbons CP, Trowbridge EA, Bannister JJ, Read NW (1986) Role of anal cushions in maintaining continence. Lancet 1:886–888CrossRefPubMedGoogle Scholar
  14. Grace RH, Creed A (1975) Prolasping thrombosed haemorrhoids: outcome of conservative management. Br Med J 3:354CrossRefPubMedPubMedCentralGoogle Scholar
  15. Greenspon J et al (2004) Thrombosed external haemorrhoids: outcome after conservative or surgical management. Dis Colon Rectum 47(9):1493–1498CrossRefPubMedGoogle Scholar
  16. Grosz CR (1990) A surgical treatment of thrombosed external hemorrhoids. Dis Colon Rectum 33:249–250CrossRefPubMedGoogle Scholar
  17. Guy RJ, Seow-Choen F (2003) Septic complications after treatment of haemorrhoids. Br J Surg 90:147–156CrossRefPubMedGoogle Scholar
  18. Haas PA, Fox TA Jr (1980) Age-related changes and scar formations of perianal connective tissue. Dis Colon Rectum 23:160–169CrossRefPubMedGoogle Scholar
  19. Haas PA, Fox TA Jr, Haas GP (1984) The pathogenesis of hemorrhoids. Dis Colon Rectum 27:442–450CrossRefPubMedGoogle Scholar
  20. Hansen JB, Jorgensen SJ (1975) Radical emergency operation for prolapsed and strangulated haemorrhoids. Acta Chir Scand 141:810–812PubMedGoogle Scholar
  21. Heald RJ, Gudgeon AM (1986) Limited haemorrhoidectomy in the treatment of acute strangulated haemorrhoids. Br J Surg 73:1002CrossRefPubMedGoogle Scholar
  22. Howard PM, Pingree JH (1968) Immediate radical surgery for hemorrhoidal disease with acute extensive thrombosis. Am J Surg 116:777–778CrossRefPubMedGoogle Scholar
  23. Jongen J, Bach S, Stubinger SH, Bock JU (2003) Excision of thrombosed external hemorrhoid under local anesthesia: a retrospective evaluation of 340 patients. Dis Colon Rectum 46:1226–1231CrossRefPubMedGoogle Scholar
  24. Laurence AE, Murray AJ (1962) Histopathology of prolapsed and thrombosed hemorrhoids. Dis Colon Rectum 5:56–61CrossRefPubMedGoogle Scholar
  25. Lestar B, Penninckx F, Kerremans R (1989) The composition of anal basal pressure. An in vivo and in vitro study in man. Int J Color Dis 4:118–122CrossRefGoogle Scholar
  26. Loder PB, Kamm MA, Nicholls RJ, Phillips RK (1994) Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg 81:946–954CrossRefPubMedGoogle Scholar
  27. Lunniss PJ, Phillips RK (1992) Anatomy and function of the anal longitudinal muscle. Br J Surg 79:882–884CrossRefPubMedGoogle Scholar
  28. Mann CV (ed) (2002) Surgical treatment of haemorrhoids. Springer, LondonGoogle Scholar
  29. Mason P (2010) Napoleon’s haemorrhoids: and other small events that changed the world. Skyhorse Publishing, New YorkGoogle Scholar
  30. Mazier WP (1973) Emergency hemorrhoidectomy – a worthwhile procedure. Dis Colon Rectum 16:200–205CrossRefPubMedGoogle Scholar
  31. Meshikhes AW (2002) Efficacy of Daflon in the treatment of hemorrhoids. Saudi Med J 23:1496–1498PubMedGoogle Scholar
  32. Nicholls RJ, Glass R (1985) Coloproctology: diagnosis and outpatient management. Springer, LondonCrossRefGoogle Scholar
  33. Oh C (1989) Acute thrombosed external hemorrhoids. Mt Sinai J Med 56:30–32PubMedGoogle Scholar
  34. Parks AG (1954) A note on the anatomy of the anal canal. Proc R Soc Med 47:997–998PubMedPubMedCentralGoogle Scholar
  35. Parks AG (1955) De haemorrhois; a study in surgical history. Guys Hosp Rep 104:135–156PubMedGoogle Scholar
  36. Patti R et al (2008) Randomised clinical trial of botulinum toxin injection for pain relief in patients with thrombosed external haemorrhoids. Br J Surg 95(11):1339–1343CrossRefPubMedGoogle Scholar
  37. Perrotti P, Antropoli C, Molino D, De Stefano G, Antropoli M (2001) Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis Colon Rectum 44:405–409CrossRefPubMedGoogle Scholar
  38. Rasmussen OO, Larsen KG, Naver L, Christiansen J (1991) Emergency haemorrhoidectomy compared with incision and banding for the treatment of acute strangulated haemorrhoids. A prospective randomised study. Eur J Surg 157:613–614PubMedGoogle Scholar
  39. Saleeby RG Jr et al (1991) Hemorrhoidectomy during pregnancy: risk or relief? Dis Colon Rectum 34:260–261CrossRefPubMedGoogle Scholar
  40. Smith M (1967) Early operation for acute haemorrhoids. Br J Surg 54:141–144CrossRefPubMedGoogle Scholar
  41. The Standards Task Force American Society of Colon and Rectal Surgeons (1993) Practice parameters for the treatment of hemorrhoids. Dis Colon Rectum 36:1118–1120CrossRefGoogle Scholar
  42. Thomson WH (1975) The nature of haemorrhoids. Br J Surg 62:542–552CrossRefPubMedGoogle Scholar
  43. Thomson H (1982) The real nature of "perianal haematoma". Lancet 2:467–468CrossRefPubMedGoogle Scholar
  44. Thulesius O, Gjores JE (1973) Arterio-venous anastomoses in the anal region with reference to the pathogenesis and treatment of haemorrhoids. Acta Chir Scand 139:476–478PubMedGoogle Scholar
  45. Tinckler LF, Baratham G (1964) Immediate haemorrhoidectomy for prolapsed piles. Lancet 14:1145–1146CrossRefGoogle Scholar
  46. Wong JC et al (2008) Stapled technique for acute thrombosed hemorrhoids: a randomized, controlled trial with long-term results. Dis Colon Rectum 51:397–403CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Alexander Hardy
    • 1
  1. 1.Peterborough City HospitalPeterboroughUK

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