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.
This is a preview of subscription content, log in via an institution.
References
Ackland TH (1961) The treatment of prolapsed gangrenous haemorrhoids. Aust N Z J Surg 30:201–203
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):41–45
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 3:175–178
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 166:808–812
Cook TA, Humphreys MM, McC Mortensen NJ (1999) Oral nifedipine reduces resting anal pressure and heals chronic anal fissure. Br J Surg 86:1269–1273
Corman ML et al (2003) Stapled haemorrhoidopexy: a consensus position paper by an international working party - indications, contra-indications and technique. Color Dis 5:304–310
Deen KI (1996) Outpatient treatment of isolated strangulated haemorrhoids with single dose injection sclerotherapy and oral Daflon. Eur J Surg 162:403–405
Eu KW, Seow-Choen F, Goh HS (1994) Comparison of emergency and elective haemorrhoidectomy. Br J Surg 81:308–310
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 57:331–339
Ganchrow MI, Mazier WP, Friend WG, Ferguson JA (1971a) Hemorrhoidectomy revisited – a computer analysis of 2,038 cases. Dis Colon Rectum 14:128–133
Ganchrow MI, Bowman HE, Clark JF (1971b) Thrombosed hemorrhoids: a clinicopathologic study. Dis Colon Rectum 14:331–340
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):339–345
Gibbons CP, Trowbridge EA, Bannister JJ, Read NW (1986) Role of anal cushions in maintaining continence. Lancet 1:886–888
Grace RH, Creed A (1975) Prolasping thrombosed haemorrhoids: outcome of conservative management. Br Med J 3:354
Greenspon J et al (2004) Thrombosed external haemorrhoids: outcome after conservative or surgical management. Dis Colon Rectum 47(9):1493–1498
Grosz CR (1990) A surgical treatment of thrombosed external hemorrhoids. Dis Colon Rectum 33:249–250
Guy RJ, Seow-Choen F (2003) Septic complications after treatment of haemorrhoids. Br J Surg 90:147–156
Haas PA, Fox TA Jr (1980) Age-related changes and scar formations of perianal connective tissue. Dis Colon Rectum 23:160–169
Haas PA, Fox TA Jr, Haas GP (1984) The pathogenesis of hemorrhoids. Dis Colon Rectum 27:442–450
Hansen JB, Jorgensen SJ (1975) Radical emergency operation for prolapsed and strangulated haemorrhoids. Acta Chir Scand 141:810–812
Heald RJ, Gudgeon AM (1986) Limited haemorrhoidectomy in the treatment of acute strangulated haemorrhoids. Br J Surg 73:1002
Howard PM, Pingree JH (1968) Immediate radical surgery for hemorrhoidal disease with acute extensive thrombosis. Am J Surg 116:777–778
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 46:1226–1231
Laurence AE, Murray AJ (1962) Histopathology of prolapsed and thrombosed hemorrhoids. Dis Colon Rectum 5:56–61
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 4:118–122
Loder PB, Kamm MA, Nicholls RJ, Phillips RK (1994) Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg 81:946–954
Lunniss PJ, Phillips RK (1992) Anatomy and function of the anal longitudinal muscle. Br J Surg 79:882–884
Mann CV (ed) (2002) Surgical treatment of haemorrhoids. Springer, London
Mason P (2010) Napoleon’s haemorrhoids: and other small events that changed the world. Skyhorse Publishing, New York
Mazier WP (1973) Emergency hemorrhoidectomy – a worthwhile procedure. Dis Colon Rectum 16:200–205
Meshikhes AW (2002) Efficacy of Daflon in the treatment of hemorrhoids. Saudi Med J 23:1496–1498
Nicholls RJ, Glass R (1985) Coloproctology: diagnosis and outpatient management. Springer, London
Oh C (1989) Acute thrombosed external hemorrhoids. Mt Sinai J Med 56:30–32
Parks AG (1954) A note on the anatomy of the anal canal. Proc R Soc Med 47:997–998
Parks AG (1955) De haemorrhois; a study in surgical history. Guys Hosp Rep 104:135–156
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):1339–1343
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 44:405–409
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 157:613–614
Saleeby RG Jr et al (1991) Hemorrhoidectomy during pregnancy: risk or relief? Dis Colon Rectum 34:260–261
Smith M (1967) Early operation for acute haemorrhoids. Br J Surg 54:141–144
The Standards Task Force American Society of Colon and Rectal Surgeons (1993) Practice parameters for the treatment of hemorrhoids. Dis Colon Rectum 36:1118–1120
Thomson WH (1975) The nature of haemorrhoids. Br J Surg 62:542–552
Thomson H (1982) The real nature of "perianal haematoma". Lancet 2:467–468
Thulesius O, Gjores JE (1973) Arterio-venous anastomoses in the anal region with reference to the pathogenesis and treatment of haemorrhoids. Acta Chir Scand 139:476–478
Tinckler LF, Baratham G (1964) Immediate haemorrhoidectomy for prolapsed piles. Lancet 14:1145–1146
Wong JC et al (2008) Stapled technique for acute thrombosed hemorrhoids: a randomized, controlled trial with long-term results. Dis Colon Rectum 51:397–403
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this entry
Cite this entry
Hardy, A. (2017). The Acute Management of Hemorrhoids. In: Ratto, C., Parello, A., Litta, F. (eds) Hemorrhoids. Coloproctology. Springer, Cham. https://doi.org/10.1007/978-3-319-51989-0_11-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-51989-0_11-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-51989-0
Online ISBN: 978-3-319-51989-0
eBook Packages: Springer Reference MedicineReference Module Medicine