Successful non-surgical management of all degree hemorrhoids


  • Ambreen Mannan Department of General Surgery, Isra University Hospital, Hyderabad, Sindh, Pakistan
  • Tek Chnad Maheshwari Department of General Surgery, Isra University Hospital, Hyderabad, Sindh, Pakistan
  • Suhail Ahmed Soomro Department of General Surgery, Isra University Hospital, Hyderabad, Sindh, Pakistan



Conservative treatment, Hemorrhoid, Surgery


Background: To evaluate the patients with primary hemorrhoids after employing mainly the non-surgical treatment in all degree hemorrhoids.

Methods: A prospective and descriptive study over three hundred and fifty (350) patients in four-year period. Concomitant anal fissure, anal fistula, secondary hemorrhoids, and recurrent hemorrhoids were excluded from the study.

Results: Total 350 patients (age range-18-80 years). Female340 (97.14%) and male10 (2.58%) admitted in surgical OPD of three different hospitals during the period of Feb 2013- Jan 2017. All patients were thoroughly examined abdominally and per rectally and proctoscopied as well to rule out concomitant pelvic and perineal pathologies. All proctoscopic findings and treatment were done by single surgeon. Treatment of hemorrhoids was categorized into three types. Type I, conservative (fiber +oral lubricants + in jeer + micronized purified flavonoid fraction + sitz bath), type II, injection sclerotherapy & type III, surgery (open Hemorrhoidectomy). All degree hemorrhoids were first kept on conservative treatment and followed weekly for bleeding and hemorrhoid swelling. Only 38.57% required Injection sclerotherapy in cases where conservative treatment was failed, large hemorrhoid swelling (> 2cm size) seen on first proctoscopy and in cases where frequent fresh bleeding episodes found either on every 2nd-3rd day or every passage of stool. Strangulated bleeding hemorrhoids dealt with anal strapping, conservative treatment and later with injection sclerotherapy, which was given after resolution of bleeding and strangulation. Open hemorrhoidectomy was done in non-compliant and in patients with exclusive external hemorrhoids.

Conclusions: Although conservative oral therapy has been given appreciating results but in adjunct with injection sclerotherapy the optimal results were promising.


Robert AG. The evaluation and treatment of hemorrhoids: a guide for the gastroenterologist. Clin Gastroenterol Hepatol. 2013;11(6):593-603.

Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL, et al. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum. 2011;54:1059-64.

Cleator IG, Cleator MM. Banding hemorrhoids using the O'Regan disposable bender. US Gastroenterology Review. 2005;5:69-73.

Sardinha TC, Corman ML. Hemorrhoids. Surg Clin North Am. 2002;82:1153-67.

Abramowitz L, Weyandt GH, Havlickova B, Matsuda Y, Didelot JM, Rothhaar A, et al. the diagnosis and management of hemorrhoid disease from a global perspective. Aliment Pharmacol Ther. 2010;31(1):1-58.

Sundaram, Viji. Don’t go easy on Turmeric: it prevents and cures cancer. India west 2005. Available at

C- Vijaya KR. Antioxidant activity of fresh and dry fruits commonly consumed in India. Food research International. 2010;43(1):286-8.

Schubert MC, Sridhar S, Schade RR, Wexner SD. What every gastroenterologist needs to know about common anorectal disorders. World J Gastroenterol. 2009;15:3201-9.

MacRae HM, Larissa KF, McLeod RS. Meta- analysis of hemorrhoidal treatments. Semin Colon Rect Surg. 2002;13:77-83.

Hain JM. The Medical treatment of hemorrhoids using flavonoids. Pract Gastroenterol. 2011:1-5.

Lohsiriwat V. Hemorrhoid: from basic pathophysiology to clinical management. World J Gastroenterol. 2012:18(17);2009-17.

Mad off RD, Fleishman JW. Clinical Practice Committee and American Gastroenterological Association: technical review on the diagnosis and treatment of hemorrhoids. Gastroenterol. 2004;126:1463-73.

Cataldo P, Ellis CN, Gregorcyk S, Hyman N, Buie WD, Church J, et al. Practice parameters for the management of hemorrhoids (revised): Standards Practice Task Force-the American Society of Colon and Rectal Surgeons. Dis Colon Rectum. 2005:48:189-94.

Giordano P, Overton J, Madeddu F, Zaman S, Gravante G. Trans anal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum. 2009;52:1665-71.

Asif Z. Management of hemorrhoids. Guidelines developed by: society of Surgeons of Pakistan, first edition. 2015:12.

Khoury GA, Lake SP, Lewis MC, Lewis AA. A randomized trial to compare single with multiple phenol injection treatment for hemorrhoids. Br J Surg. 1985;72:741-2.

Senapati A, Nicholls RJ. A randomized trial to compare the results of injection sclerotherapy with a bulk laxative alone in the treatment of bleeding hemorrhoids. Int J Colorectal Dis. 1988;3:124-6.

Al-Ghnaniem R, Leather AJ, Rennie JA. Survey of methods of treatment of hemorrhoids and complications of injection sclerotherapy. Ann R Coll Surg Engl. 2001;83:325-8.

Shafik A. Role of warm-water bath in anorectal conditions: the “thermosphincteric reflex”. J Clin Gastroenterol. 1993;16:304-8.






Original Research Articles