Haemorrhoids (uncomplicated)
Introduction
Classification
External
- originate below the dentate line
- prone to thrombosis, may be painful
Internal
- originate above the dentate line
- do not generally cause pain
Grading of internal haemorrhoids
Grade I | Do not prolapse out of the anal canal |
---|---|
Grade II | Prolapse on defecation but reduce spontaneously |
Grade III | Can be manually reduced |
Grade IV | Cannot be reduced |
Epidemiology
- Incidence: 1000.00 cases per 100,000 person-years
- Peak incidence: 40-50 years
- Sex ratio: 1:1
<1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Clinical features
- painless rectal bleeding is the most common symptom
- pruritus
- pain: usually not significant unless piles are thrombosed
- soiling may occur with third or forth degree piles
Management
- soften stools: increase dietary fibre and fluid intake
- topical local anaesthetics and steroids may be used to help symptoms
- outpatient treatments: rubber band ligation is superior to injection sclerotherapy
- surgery is reserved for large symptomatic haemorrhoids which do not respond to outpatient treatments
- newer treatments: Doppler guided haemorrhoidal artery ligation, stapled haemorrhoidopexy
Complications
- thrombosed haemorrhoid