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Hemorrhoids

Last reviewed: 12 Nov 2024
Last updated: 27 Sep 2024

Summary

Definition

History and exam

Key diagnostic factors

  • rectal bleeding
  • intermittent protrusion
  • perianal pain/discomfort
Full details

Other diagnostic factors

  • anal pruritus
  • tender palpable perianal lesion
  • anal mass
Full details

Risk factors

  • age between 45-65 years
  • constipation
  • pregnancy or space-occupying pelvic lesion
  • hepatic insufficiency
  • ascites
Full details

Diagnostic tests

1st tests to order

  • anoscopic exam
  • colonoscopy/flexible sigmoidoscopy
  • CBC
  • stool for occult heme
Full details

Treatment algorithm

ACUTE

initial presentation: nonpregnant

initial presentation: pregnant

ONGOING

treatment failure of rubber band ligation, sclerotherapy, infrared coagulation, hemorrhoidal arterial ligation, or stapled hemorrhoidopexy

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

Faculty 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.

Jayan Dewanta Jayasinghe, MD, FRCS (Gen Surg), FEBS (Coloproctology)

Senior Colorectal Fellow

Barts Health NHS Trust

Colorectal & Pelvic Floor Services

Royal London Hospital

London

UK

Disclosures

JDJ declares that he has no competing interests.

Acknowledgements

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

Disclosures

KGD declares that he has no competing interests.

Peer reviewers

Tisha N. Lunsford, MD, FACG, AGA

Director of Motility

Mayo Clinic Arizona

Phoenix

AZ

Disclosures

TNL declares that she has no competing interests.

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.

  • Hemorrhoids images
  • Differentials

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    • Ulcerative colitis
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  • Guidelines

    • The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids
    • Australian Department of Health pregnancy care guidelines: common conditions during pregnancy
    More Guidelines
  • Patient information

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