Hemorrhoidal diseases.


Otto P, Otto JU.




Schweiz Rundsch Med Prax.


Main symptoms associated with hemorrhoids are anal bleeding, pruritus as well as weeping and superficial wounds of the rima ani and, finally, hemorrhoidal prolapse. The reason for the symptoms described is a relative anal incontinence due to hemorrhoidal knots prolapsing into the anal channel. There is evidence of an increased sphincteric pressure following increase of intraluminal pressure in colon and rectum in patients whose volumes of stool are too little because of small amounts of dietary fiber or regular use of laxatives. The stop of venous blood flow leads to a constant swelling of the vascular bed in the anal channel, which herniates during defection with variable intensity. Almost half of the patients suffering from hemorrhoids of grade 1 or grade 2 are treated successfully and conservatively (regulation of bowel habits by intake of large quantities of dietary fiber, change of life style and training of sphincter ani). Although injection therapy is used mostly, ligation of the prolapsing knots is the most physiological form of treatment: in retaining the vascular bed, the patient is able to keep complete continence. The consequent use of the former mentioned modes of treatment gives a 95% success rate in patients suffering from hemorrhoids. Only 5% need surgical intervention.