Hemorrhoids: which is the best therapeutic option?

Ketan Vagholkar, Shreyas Chawathey, Shantanu Shekhar, Suvarna Vagholkar


Hemorrhoids are one of the commonest of rectal diseases seen all across the globe. Constipation and bleeding are the main symptoms associated with this condition. The condition maybe associated with an underlying carcinoma as well. Understanding the pathophysiology will enable the surgeon to determine the best therapeutic option for this condition. A brief review of clinical evaluation and treatment options is presented in this paper.


Haemorrhoids, Non-operative Piles, Pathology, Surgical, Treatment

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Loder PB, Kamm MA, Nicholls RJ, Phillips RK. Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg. 1994;81:946-54.

Aigner F, Gruber H, Conrad F, Eder J, Wedel T, Zelger B, et al. Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease. Int J Colorectal Dis. 2009;24:105-13.

Lunniss PJ, Mann CV. Classification of internal haemorrhoids: a discussion paper. Colorectal Dis. 2004;6:226-32.

Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: A comprehensive review. J Am Coll Surg. 2007;204:102-17.

Harish K, Harikumar R, Sunilkumar K, Thomas V. Videoanoscopy: useful technique in the evaluation of hemorrhoids. J Gastroenterol Hepatol. 2008; 23:e312-7.

Pigot F, Siproudhis L, Allaert FA. Risk factors associated with hemorrhoidal symptoms in specialized consultation. Gastroenterol Clin Biol. 2005;29:1270-4.

Alonso-Coello P, Mills E, Heels-Ansdell D, López-Yarto M, Zhou Q, Johanson JF, Guyatt G. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101:181-8.

Misra MC. Drug treatment of haemorrhoids. Drugs. 2005; 65:1481-91.

Johanson JF. Nonsurgical treatment of hemorrhoids. J Gastrointest Surg. 2002;6:290-4.

Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, Mills E, Heels-Ansdell D, Johanson JF, et al. Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg. 2006;93:909-20.

Tjandra JJ, Tan JJ, Lim JF, Murray-Green C, Kennedy ML, Lubowski DZ. Rectogesic (glyceryl trinitrate 0.2%) ointment relieves symptoms of haemorrhoids associated with high resting anal canal pressures. Colorectal Dis. 2007;9:457-63.

Acheson AG, Scholefield JH. Management of haemorrhoids. BMJ. 2008;336:380-3.

MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum. 1995;38:687-94.

Faucheron JL, Gangner Y. Doppler-guided hemorrhoidal artery ligation for the treatment of symptomatic hemorrhoids: early and three-year follow-up results in 100 consecutive patients. Dis Colon Rectum. 2008;51:945-9.

Johanson JF, Rimm A. Optimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation, and injection sclerotherapy. Am J Gastroenterol. 1992; 87:1600-06.

Giordano P, Gravante G, Sorge R, Ovens L, Nastro P. Long-term outcomes of stapled hemorrhoidopexy vs conventional hemorrhoidectomy: a meta-analysis of randomized controlled trials. Arch Surg. 2009; 144:266-72.

Beattie GC, Wilson RG, Loudon MA. The contemporary management of haemorrhoids. Colorectal Dis. 2002;4:450-4.

Chen JS, You JF. Current status of surgical treatment for hemorrhoids-systematic review and meta-analysis. Chang Gung Med J. 2010;33:488-500.

Shao WJ, Li GC, Zhang ZH, Yang BL, Sun GD, Chen YQ. Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J Surg. 2008;95:147-60.

Cintron JR, Abcarian H. Benign Anorectal: Hemorrhoids. The ASCRS Textbook of Colon and Rectal Surgery. New York: Springer; 2007;156-77.