Summary
Definition
History and exam
Key diagnostic factors
- rectal bleeding
- intermittent protrusion
- perianal pain/discomfort
Other diagnostic factors
- anal pruritus
- tender palpable perianal lesion
- anal mass
Risk factors
- age between 45-65 years
- constipation
- pregnancy or space-occupying pelvic lesion
- hepatic insufficiency
- ascites
Diagnostic investigations
1st investigations to order
- anoscopic exam
- colonoscopy/flexible sigmoidoscopy
- CBC
- stool for occult heme
Treatment algorithm
all patients at presentation
treatment failure of rubber band ligation, sclerotherapy, infrared coagulation, transanal hemorrhoidal dearterialization, 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
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.
Differentials
- Anal fissure
- Crohn disease
- Ulcerative colitis
More DifferentialsGuidelines
- ACG clinical guidelines: management of benign anorectal disorders
- The European Society of Coloproctology: guideline for haemorrhoidal disease
More GuidelinesPatient leaflets
Anal tears
Hemorrhoids
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