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==Overview==
==Overview==
 
If left untreated, hemorrhoids may lead to [[strangulation]], [[anemia]], or [[fecal incontinence]]. Common complications of hemorrhoids include [[secondary infection]], [[thrombosis]], or [[strangulation]]. Prognosis is generally excellent and most cases respond to non surgical treatment. However, surgery gives the best prognosis with the least recurrence rate.
==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
===Natural History===
===Natural History===
The common man in general tolerates the disease for a long time ,self treating with lot of ointments available over the counter and seeks medical aid only when intolerable
*If left untreated, hemorrhoids may lead to [[strangulation]], [[thrombosis]], or [[infection]].
 
*The main reasons for a delay in seeking medical advice are as follows:
The main reasons for seeking delayed advise are as follows:
:*Myths about the surgical treatment
*Myths about the surgical treatment
:*Postoperative pain  
*Postoperative pain  
:*Fear of [[incontinence]] after surgery<ref name="pmid28567655">{{cite journal |vauthors=Guttenplan M |title=The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist |journal=Curr Gastroenterol Rep |volume=19 |issue=7 |pages=30 |year=2017 |pmid=28567655 |doi=10.1007/s11894-017-0574-9 |url=}}</ref>
*Fear of incontinence after surgery


===Complications===
===Complications===
** '''Prolapsed hemorrhoids''' are internal hemorrhoids that are so distended that they are pushed outside the anus.
====Most common complications====
** If the anal [[sphincter]] muscle goes into [[spasm]] and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a '''strangulated hemorrhoid'''.
*[[Strangulation|Strangualtion]]: The prolapsed hemorrhoids can be trapped outside the [[anal canal]] if the [[anal sphincter]] goes into [[spasm]]. This can lead to [[thrombosis]] of the hemorrhoids or cutting of the blood supply to the hemorrhoids
*[[Secondary infection]] and [[abscess]] formation
*Hemorrhoid [[thrombosis]]
====Less common complications====
*[[Anemia]] due to [[chronic]] bleeding
*[[Fecal incontinence]]
====Complications due to surgery====
*Anal [[stenosis]]
*Wound dehisence
*Wound [[sepsis]]
*[[Fistula]] formation


===Prognosis===
===Prognosis===
Hemorrhoids are not dangerous, and only need to be treated if they cause very bothersome symptoms. If hemorrhoids occur during pregnancy, they will usually regress spontaneously after childbirth. For hemorrhoids related to constipation, the prognosis is also good, provided you make the necessary changes to your diet and lifestyle. For hemorrhoids that cause persistent symptoms despite nonsurgical treatment, the results from office treatment or surgery are usually very good.
*The prognosis is excellent.
*Most cases respond well to non surgical procedures such as [[rubber band ligation]] (recurrence rate is 30-50% after 5 years); however, the recurrence rate is much less with surgical [[hemorrhoidectomy]] (2-5% after 5 years).<ref name="pmid17665254">{{cite journal |vauthors=Jayaraman S, Colquhoun PH, Malthaner RA |title=Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery |journal=Dis. Colon Rectum |volume=50 |issue=9 |pages=1297–305 |year=2007 |pmid=17665254 |doi=10.1007/s10350-007-0308-4 |url=}}</ref><ref name="pmid16034963">{{cite journal |vauthors=Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA |title=Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD005034 |year=2005 |pmid=16034963 |doi=10.1002/14651858.CD005034.pub2 |url=}}</ref>
*The difference in recurrence rate is more pronounced with grade III hemorrhoids.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
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[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Surgery]]
[[Category:Primary care]]
[[Category:Needs overview]]
[[Category:Needs overview]]
[[Category:Needs content]]
[[Category:Needs content]]
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Latest revision as of 22:03, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

If left untreated, hemorrhoids may lead to strangulation, anemia, or fecal incontinence. Common complications of hemorrhoids include secondary infection, thrombosis, or strangulation. Prognosis is generally excellent and most cases respond to non surgical treatment. However, surgery gives the best prognosis with the least recurrence rate.

Natural History, Complications and Prognosis

Natural History

  • Myths about the surgical treatment
  • Postoperative pain
  • Fear of incontinence after surgery[1]

Complications

Most common complications

Less common complications

Complications due to surgery

Prognosis

  • The prognosis is excellent.
  • Most cases respond well to non surgical procedures such as rubber band ligation (recurrence rate is 30-50% after 5 years); however, the recurrence rate is much less with surgical hemorrhoidectomy (2-5% after 5 years).[2][3]
  • The difference in recurrence rate is more pronounced with grade III hemorrhoids.

References

  1. ↑ Guttenplan M (2017). "The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist". Curr Gastroenterol Rep. 19 (7): 30. doi:10.1007/s11894-017-0574-9. PMID 28567655.
  2. ↑ Jayaraman S, Colquhoun PH, Malthaner RA (2007). "Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery". Dis. Colon Rectum. 50 (9): 1297–305. doi:10.1007/s10350-007-0308-4. PMID 17665254.
  3. ↑ Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA (2005). "Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids". Cochrane Database Syst Rev (3): CD005034. doi:10.1002/14651858.CD005034.pub2. PMID 16034963.

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