eMedicine Specialties > General Surgery > Colorectal

Hemorrhoids: Follow-up

Author: Scott C Thornton, MD, Associate Clinical Professor of Surgery, Yale University School of Medicine; Director, Colorectal Teaching, Bridgeport Hospital; Private Practice, Colon and Rectal Surgeons
Contributor Information and Disclosures

Updated: Mar 16, 2010

Outcome and Prognosis

Accurately classifying a patient's symptoms and the relation of the symptoms to internal and external hemorrhoids is important. Internal hemorrhoid symptoms often respond to increased fiber and liquid intake and to avoidance of straining and prolonged toilet sitting. Nonoperative therapy works well for symptoms that persist despite the use of conservative therapy.

PPH is an excellent alternative for treating internal hemorrhoids that have not been amenable to conservative or nonoperative approaches. Short- and medium-term results are excellent. Patients with minimal external tags and large internal hemorrhoids are easily treated with PPH and skin tag excision. Operative resection is sometimes required to control the symptoms of internal hemorrhoids.

External hemorrhoid symptoms are generally divided into problems with acute thrombosis and hygiene/skin tag complaints. The former respond well to office excision (not enucleation), while operative resection is reserved for the latter. Remember that therapy is directed solely at the symptoms, not at aesthetics.

When performed well, operative hemorrhoidectomy should have a 2-5% recurrence rate. Nonoperative techniques, such as rubber band ligation, produce recurrence rates of 30-50% within 5-10 years. However, these recurrences can usually be addressed with further nonoperative treatments.15 Long-term results from PPH are unavailable at this time.25,31,32

Future and Controversies

The major controversies regarding the treatment of hemorrhoids center on the indications for treatment and the choice of operative versus nonoperative therapy. Most experienced surgeons are using office-based nonoperative therapies and are relying less on operative hemorrhoidectomy than they previously were. In the United States, rubber band ligation (compared with injection sclerotherapy) is the mainstay of conservative treatment. PPH, which has been gaining increasing favor in the United States, provides an excellent alternative to operative hemorrhoidectomy for patients with minimal external disease and large internal hemorrhoids.

 


More on Hemorrhoids

Overview: Hemorrhoids
Workup: Hemorrhoids
Treatment: Hemorrhoids
Follow-up: Hemorrhoids
References
Further Reading
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Further Reading

Related eMedicine topics:
Constipation [Emergency Medicine]
Constipation [Gastroenterology]
Constipation [Pediatrics: General Medicine]
Constipation and Bowel Management
Crohn Disease [Gastroenterology]
Crohn Disease [Pediatrics: General Medicine]
Crohn Disease [Radiology]
Hemorrhoids [Emergency Medicine]
Inflammatory Bowel Disease [Emergency Medicine]
Inflammatory Bowel Disease [Gastroenterology]
Inflammatory Bowel Disease [Ophthalmology]
Portal Hypertension [Gastroenterology]
Portal Hypertension [Radiology]
Rectal Prolapse [Emergency Medicine]
Rectal Prolapse [General Surgery]
Rectal Prolapse [Pediatrics: General Medicine]
Rectal Prolapse: Surgical Perspective
Thrombosed External Hemorrhoid Excision
Ulcerative Colitis [Gastroenterology]
Ulcerative Colitis [Pediatrics: General Medicine]
Ulcerative Colitis [Radiology]

Clinical guidelines:
Practice parameters for the management of hemorrhoids (revised). American Society of Colon and Rectal Surgeons - Medical Specialty Society. 1993 (revised 2005 Feb). 6 pages. NGC:004337

Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). American Society of Colon and Rectal Surgeons - Medical Specialty Society. 1996 (revised 2005 Jul). 6 pages. NGC:004432

Stapled haemorrhoidopexy for the treatment of haemorrhoids. National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.]. 2007 Sep

Clinical studies:
EnSeal Device Versus Ferguson Technique in Hemorrhoidectomy

Is Doppler Necessary in Haemorrhoidal Artery Ligation Operation?

Prospective Randomized Trial Comparing THD Versus Stapler Operation for 3rd Degree Hemorrhoids (THD/stapler)

Recto Anal Repair or Milligan Morgans Operation of Grade 3 and 4 Symptomatic Haemorrhoidal Disease

Study of a New Circular Anal Dilator

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Keywords

hemorrhoids, piles, hemorrhoid, external hemorrhoids, internal hemorrhoids, hemorrhoids treatment, external hemorrhoid, hemorrhoids surgery, hemorrhoidectomy, hemorrhoidal, hemorrhoids pregnancy, bleeding hemorrhoids, thrombosed hemorrhoids, hemorrhoids cure, hemorrhoids symptoms, hemorrhoids cause, hemorrhoids pain, internal hemorrhoid, prolapsed hemorrhoid

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Contributor Information and Disclosures

Author

Scott C Thornton, MD, Associate Clinical Professor of Surgery, Yale University School of Medicine; Director, Colorectal Teaching, Bridgeport Hospital; Private Practice, Colon and Rectal Surgeons
Scott C Thornton, MD is a member of the following medical societies: American Society of Colon and Rectal Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Brian James Daley, MD, MBA, FACS, Associate Program Director, Professor, Department of Surgery, Division of Trauma and Critical Care, University of Tennessee School of Medicine
Brian James Daley, MD, MBA, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Eastern Association for the Surgery of Trauma, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael A Grosso, MD, Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital
Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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