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Hemorrhoids pp 183-189 | Cite as

Literature Review on Outpatient Treatments for Hemorrhoids

  • Fabio Gaj
  • Jacopo Andreuccetti
  • Ivano Biviano
Reference work entry
Part of the Coloproctology book series (COLOPROCT, volume 2)

Abstract

The chapter focuses on literature review on outpatient treatments for hemorrhoids, involving medical management, and above all office-based procedures, for symptomatic low-grade internal hemorrhoids according to the Goligher’s classification.

A wide range of options are available, and the choice is based on several aspects that may depend on surgeon preference and experience, equipment availability, patient medical comorbidities, and patient preference. Correction of lifestyle and dietary habits are the initial preventive measures. Conservative approaches are recommended initially for patients with low-grade disease and in particular for pregnant, immunocompromised, in coagulation disorders, cirrhosis, and Crohn’s disease. Medical management for symptomatic hemorrhoids can be distinguished in oral and topical treatment; however, there are no evidence showing their benefit for prevention or long-term treatment of hemorrhoid disease.

Nonoperative treatments are generally done in the office or endoscopy suite, without the need for anesthesia or preparation of the patient and they have the advantage that patients resume normal activities after treatment. These techniques do not have effect on any external hemorrhoid, and rubber band ligation (RBL) is currently the most widespread outpatient treatment. Complications are usually minor with range from 3% to 8%, and banding has the best outcome with first- and second-degree hemorrhoids, with 70–90% success after one treatment.

Other office-based procedures include injection sclerotherapy with a high degree of initial success in decreasing bleeding and pain and infrared photocoagulation, bipolar diathermy, and direct current electrotherapy. All these techniques have success rates inferior to RBL in randomized studies.

Abbreviations

HAL

Hemorrhoidal artery ligation

HeLP

Hemorrhoid laser procedure

IRC

Infrared coagulation

RBL

Rubber band ligation

References

  1. Alonso-Coello P, Mills E, Heels-Ansdell D, López-Yarto M, Zhou Q, Johanson JF, Guyatt G (2006a) Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Am J Gastroenterol 101(1):181–188CrossRefPubMedCentralPubMedGoogle Scholar
  2. Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, Mills E, Heels-Ansdell D, Johanson JF, Guyatt G (2006b) Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg 93:909–920CrossRefPubMedCentralPubMedGoogle Scholar
  3. Barwell J, Watkins RM, Lloyd-Davies E, Wilkins DC (1999) Life-threatening retroperitoneal sepsis after hemorrhoid injection sclerotherapy: report of a case. Dis Colon Rectum 42(3):421–423CrossRefPubMedCentralPubMedGoogle Scholar
  4. Brown SR, Tiernan JP, Watson AJ, Biggs K, Shephard N, Wailoo AJ, Bradburn M, Alshreef A, Hind D, HubBLe Study team (2016) Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial. Lancet 388(10042):356–364CrossRefPubMedCentralPubMedGoogle Scholar
  5. Bryant-Waugh R, Turner H, East P, Gamble C, Mehta R (2006) Misuse of laxatives among adult outpatients with eating disorders: prevalence and profiles. Int J Eat Disord 39(5):404–409CrossRefPubMedCentralPubMedGoogle Scholar
  6. Cataldo P, Ellis CN, Gregorcyk S, Hyman N, Buie WD, Church J, Cohen J, Fleshner P, Kilkenny J 3rd, Ko C, Levien D, Nelson R, Newstead G, Orsay C, Perry WB, Rakinic J, Shellito P, Strong S, Ternent C, Tjandra J, Whiteford M (2005) Practice parameters for the management of hemorrhoids (revised). Dis Colon Rectum 48:189–194CrossRefPubMedCentralPubMedGoogle Scholar
  7. Crosland A, Jones R (1995) Rectal bleeding: prevalence and consultation behaviour. BMJ 311:486–488CrossRefPubMedCentralPubMedGoogle Scholar
  8. El Nakeeb AM, Fikry AA, Omar WH, Fouda EM, El Metwally TA, Ghazy HE, Badr SA, Abu Elkhar MY, Elawady SM, Abd Elmoniam HH, Khafagy WW, Morshed MM, El Lithy RE, Farid ME (2008) Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases. World J Gastroenterol 14(42):6525–6530CrossRefPubMedCentralPubMedGoogle Scholar
  9. Forlini A, Manzelli A, Quaresima S, Forlini M (2009) Long-term result after rubber band ligation for haemorrhoids. Int J Color Dis 24(9):1007–1010CrossRefGoogle Scholar
  10. Gaj F, Biviano I, Sportelli G, Candeloro L (2015) Rubber band ligation in treatment of hemorrhoids: our experience. Clin Ter 166(4):162–167PubMedPubMedCentralGoogle Scholar
  11. Giamundo P, Salfi R, Geraci M, Tibaldi L, Murru L, Valente M (2011) The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum 54:693–698CrossRefPubMedCentralPubMedGoogle Scholar
  12. Guindic LC (2014) Treatment of uncomplicated hemorrhoids with a Hemor-Rite® cryotherapy device: a randomized, prospective, comparative study. J Pain Res 7:57–63PubMedPubMedCentralGoogle Scholar
  13. Hachiro Y, Kunimoto M, Abe T, Kitada M, Ebisawa Y (2007) Aluminum potassium sulfate and tannic acid injection in the treatment of total rectal prolapse: early outcomes. Dis Colon Rectum 50(11):1996–2000CrossRefPubMedCentralPubMedGoogle Scholar
  14. He X, Bai Y, Zhao Z, Wang X, Fang J, Huang L, Zeng M, Zhang Q, Zhang Y, Zheng X (2016) Local and traditional uses, phytochemistry, and pharmacology of Sophora japonica L.: a review. J Ethnopharmacol 187:160–182CrossRefPubMedCentralPubMedGoogle Scholar
  15. Hernández-Bernal F, Castellanos-Sierra G, Valenzuela-Silva CM, Catasús-Álvarez KM, Valle-Cabrera R, Aguilera-Barreto A, López-Saura PA, THERESA-3 Group of Investigators (2014) Recombinant streptokinase vs phenylephrine-based suppositories in acute hemorrhoids, randomized, controlled trial (THERESA-3). World J Gastroenterol 20(6):1594–1601CrossRefPubMedCentralPubMedGoogle Scholar
  16. Hernández-Bernal F, Castellanos-Sierra G, Valenzuela-Silva CM, Catasús-Álvarez KM, Martínez-Serrano O, Lazo-Diago OC, Bermúdez-Badell CH, Causa-García JR, Domínguez-Suárez JE, THERESA-4 (2015) Recombinant streptokinase vs hydrocortisone suppositories in acute hemorrhoids: a randomized controlled trial. World J Gastroenterol 21(23):7305–7312CrossRefPubMedCentralPubMedGoogle Scholar
  17. Ho YH, Tan M, Seow-Choen F (2000) Micronized purified flavonidic fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids: randomized controlled trial. Dis Colon Rectum 43:66–69CrossRefPubMedCentralPubMedGoogle Scholar
  18. Iyer VS, Shrier I, Gordon PH (2004) Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Dis Colon Rectum 47(8):1364–1370CrossRefPubMedGoogle Scholar
  19. Jacobs D (2014) Clinical practice. Hemorrhoids N Engl J Med 371(10):944–951CrossRefPubMedGoogle Scholar
  20. Johanson JF, Rimm A (1992) Optimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation, and injection sclerotherapy. Am J Gastroenterol 87(11):1600–1606PubMedPubMedCentralGoogle Scholar
  21. Kolbe N, Hain J (2015) Treatment of acute hemorrhoidal crisis using hyaluronidase with local anesthetic prior to surgical excision. Tech Coloproctol 19(8):487–488CrossRefPubMedCentralPubMedGoogle Scholar
  22. Linares Santiago E, Gómez Parra M, Mendoza Olivares FJ, Pellicer Bautista FJ, Herrerías Gutiérrez JM (2001) Effectiveness of hemorrhoidal treatment by rubber band ligation and infrared photocoagulation. Rev Esp Enferm Dig 93(4):238–247PubMedPubMedCentralGoogle Scholar
  23. Lohsiriwat V (2013) Approach to hemorrhoids. Curr Gastroenterol Rep 15:332CrossRefPubMedCentralPubMedGoogle Scholar
  24. MacRae HM, McLeod RS (1997) Comparison of hemorrhoidal treatments: a meta-analysis. Can J Surg 40(1):14–17PubMedPubMedCentralGoogle Scholar
  25. Marques CF, Nahas SC, Nahas CS, Sobrado CW Jr, Habr-Gama A, Kiss DR (2006) Early results of the treatment of internal hemorrhoid disease by infrared coagulation and elastic banding: a prospective randomized cross-over trial. Tech Coloproctol 10(4):312–317CrossRefPubMedCentralPubMedGoogle Scholar
  26. Masullo M, Pizza C, Piacente S (2016) Ruscus genus: a rich source of bioactive steroidal Saponins. Planta Med 82(18):1513–1524CrossRefPubMedCentralPubMedGoogle Scholar
  27. Miyamoto H, Hada T, Ishiyama G, Ono Y, Watanabe H (2016) Aluminum potassium sulfate and tannic acid sclerotherapy for Goligher grades II and III hemorrhoids: results from a multicenter study. World J Hepatol 8(20):844–849CrossRefPubMedCentralPubMedGoogle Scholar
  28. Perera N, Liolitsa D, Iype S, Croxford A, Yassin M, Lang P, Ukaegbu O, van Issum C (2012) Phlebotonics for haemorrhoids. Cochrane Database Syst Rev 8:CD004322Google Scholar
  29. Poen AC, Felt-Bersma RJ, Cuesta MA, Devillé W, Meuwissen SG (2000) A randomized controlled trial of rubber band ligation versus infra-red coagulation in the treatment of internal haemorrhoids. Eur J Gastroenterol Hepatol 12(5):535–539CrossRefPubMedCentralPubMedGoogle Scholar
  30. Rakinic J, Poola VP (2014) Hemorrhoids and fistulas: new solutions to old problems. Curr Probl Surg 51:98–137CrossRefPubMedCentralPubMedGoogle Scholar
  31. Ratnasingham K, Uzzaman M, Andreani SM, Light D, Patel B (2010) Meta-analysis of the use of glyceryl trinitrate ointment after haemorrhoidectomy as an analgesic and in promoting wound healing. Int J Surg 8(8):606–611CrossRefPubMedCentralPubMedGoogle Scholar
  32. Riss S, Weiser FA, Riss T, Schwameis K, Mittlböck M, Stift A (2011) Haemorrhoids and quality of life. Color Dis 13:e48–e52CrossRefGoogle Scholar
  33. Schulte T, Fändrich F, Kahlke V (2008) Life-threatening rectal necrosis after injection sclerotherapy for haemorrhoids. Int J Color Dis 23(7):725–726CrossRefGoogle Scholar
  34. Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA (2005) Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids. Cochrane Database Syst Rev 3:CD005034Google Scholar
  35. Su MY, Chiu CT, Lin WP, Hsu CM, Chen PC (2011) Long-term outcome and efficacy of endoscopic hemorrhoid ligation for symptomatic internal hemorrhoids. World J Gastroenterol 17(19):2431–2436CrossRefPubMedCentralPubMedGoogle Scholar
  36. Thanapongsathorn W, Vajrabukka T (1992) Clinical trial of oral diosmin (Daflon) in the treatment of hemorrhoids. Dis Colon Rectum 35:1085–1088CrossRefPubMedCentralPubMedGoogle Scholar
  37. Traynor OJ, Carter AE (1984) Cryotherapy for advanced haemorrhoids: a prospective evaluation with 2-year follow-up. Br J Surg 71(4):287–289CrossRefPubMedCentralPubMedGoogle Scholar
  38. Yano T, Asano M, Tanaka S, Oda N, Matsuda Y (2014) Prospective study comparing the new sclerotherapy and hemorrhoidectomy in terms of therapeutic outcomes at 4 years after the treatment. Surg Today 44(3):449–453CrossRefPubMedCentralPubMedGoogle Scholar
  39. Zhang T, Xu LJ, Xiang J, He Z, Peng ZY, Huang GM, Ji GZ, Zhang FM (2015) Cap-assisted endoscopic sclerotherapy for hemorrhoids: methods, feasibility and efficacy. World J Gastroenterol 7(19):1334–1340Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General Surgery and Organ Transplant, Policlinico Umberto I of RomeSapienza UniversityRomeItaly
  2. 2.General and Mini-Invasive Surgery“San Camillo” HospitalTrentoItaly
  3. 3.Department of Medicine, Surgery and Neurosciences – Unit of Gastroenterology and Digestive EndoscopyUniversity of SienaSienaItaly

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