Published online Aug 21, 2015. doi: 10.3748/wjg.v21.i31.9245
Peer-review started: January 27, 2015
First decision: April 14, 2015
Revised: April 21, 2015
Accepted: July 3, 2015
Article in press: July 3, 2015
Published online: August 21, 2015
Hemorrhoids is recognized as one of the most common medical conditions in general population. It is clinically characterized by painless rectal bleeding during defecation with or without prolapsing anal tissue. Generally, hemorrhoids can be divided into two types: internal hemorrhoid and external hemorrhoid. External hemorrhoid usually requires no specific treatment unless it becomes acutely thrombosed or causes patients discomfort. Meanwhile, low-graded internal hemorrhoids can be effectively treated with medication and non-operative measures (such as rubber band ligation and injection sclerotherapy). Surgery is indicated for high-graded internal hemorrhoids, or when non-operative approaches have failed, or complications have occurred. Although excisional hemorrhoidectomy remains the mainstay operation for advanced hemorrhoids and complicated hemorrhoids, several minimally invasive operations (including Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation and stapled hemorrhoidopexy) have been introduced into surgical practices in order to avoid post-hemorrhiodectomy pain. This article deals with some fundamental knowledge and current treatment of hemorrhoids in a view of a coloproctologist - which includes the management of hemorrhoids in complicated situations such as hemorrhoids in pregnancy, hemorrhoids in immunocompromised patients, hemorrhoids in patients with cirrhosis or portal hypertension, hemorrhoids in patients having antithrombotic agents, and acutely thrombosed or strangulated hemorrhoids. Future perspectives in the treatment of hemorrhoids are also discussed.
Core tip: Hemorrhoids is a very common anorectal disease defined as the symptomatic enlargement and/or distal displacement of anal cushions. Apart from abnormally dilated vascular channel and destructive changes in supporting tissue within anal cushions, there is emerging evidence that hemorrhoids is associated with hyperperfusion state of anorectal region and some degree of tissue inflammation. This article comprehensively and thoroughly reviews the pathophysiology, clinical diagnosis, and current treatment of hemorrhoids - which includes dietary and lifestyle modification, pharmacological approach, office-based procedures and operations for hemorrhoids (such as hemorrhoidectomy and other non-excisional surgery). The management of hemorrhoids in complicated situations is also addressed.