Haemorrhoids

Last reviewed: 7 Jun 2022
Last updated: 06 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • rectal bleeding
  • intermittent protrusion
  • perianal pain/discomfort
More key diagnostic factors

Other diagnostic factors

  • anal pruritus
  • tender palpable perianal lesion
  • anal mass
Other diagnostic factors

Risk factors

  • age between 45-65 years
  • constipation
  • pregnancy or space-occupying pelvic lesion
  • hepatic insufficiency
  • ascites
More risk factors

Diagnostic investigations

1st investigations to order

  • anoscopic examination
  • colonoscopy/flexible sigmoidoscopy
  • FBC
  • stool for occult haem
More 1st investigations to order

Treatment algorithm

ACUTE

all patients at presentation

ONGOING

treatment failure of rubber band ligation, sclerotherapy, infrared coagulation, transanal haemorrhoidal de-arterialisation, or stapled haemorrhoidopexy

Contributors

Authors

Mohamed A. Thaha, PhD, FRCS (Gen Surg), PG Cert Hlt Econ

Senior Lecturer and Consultant in Colorectal Surgery

National Bowel Research Centre (NBRC)

Blizard Institute

Barts and The London School of Medicine & Dentistry

Queen Mary University of London

Colorectal & Pelvic Floor Services

Royal London Hospital

Barts Health NHS Trust

London

UK

Disclosures

MAT declares that he has no competing interests.

Robert J.C. Steele, MD, FRCS

Professor of Surgery

Ninewells Hospital & Medical School

University of Dundee

Dundee

UK

Disclosures

RJCS declares that he has no competing interests.

Acknowledgements

Dr Mohamed A. Thaha and Professor Robert J.C. Steele would like to gratefully acknowledge Dr Kurt G. Davis and Dr Jayan D. Jayasinghe, the previous contributors to this topic.

Disclosures

KGD and JDJ declare that they have no competing interests.

Peer reviewers

George Reese, MB BS MRCS

Honorary Clinical Research Fellow

Division of Surgery

Oncology

Reproductive Biology and Anaesthetics

Imperial College

St Mary's Hospital

London

UK

Disclosures

GR declares that he has no competing interests.

Alexander von Roon, MRCS

Clinical Research Fellow

Department of Biosurgery and Surgical Technology

Imperial College

St Mary's Hospital

London

UK

Disclosures

AVR declares that he has no competing interests.

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  • Guidelines

    • ACG clinical guidelines: management of benign anorectal disorders
    • The European Society of Coloproctology: guideline for haemorrhoidal disease
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