Hemorrhoids natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, hemorrhoids may progress to develop 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. | If left untreated, hemorrhoids may progress to develop [[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=== | ||
*If left untreated, hemorrhoids may progress to develop strangulation, thrombosis or infection. | *If left untreated, hemorrhoids may progress to develop [[strangulation]], [[thrombosis]] or [[infection]]. | ||
*The main reasons for seeking delayed advise are as follows: | *The main reasons for seeking delayed advise are as follows: | ||
:*Myths about the surgical treatment | :*Myths about the surgical treatment | ||
| Line 16: | Line 16: | ||
===Complications=== | ===Complications=== | ||
====Most common complications==== | ====Most common complications==== | ||
*Strangulation: If the | *[[Strangulation]]: 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'''. | ||
*Secondary infection and abscess formation | *[[Secondary infection]] and [[abscess]] formation | ||
*Hemorrhoid thrombosis | *Hemorrhoid thrombosis | ||
====Less common complications==== | ====Less common complications==== | ||
*Anemia due to chronic bleeding | *[[Anemia]] due to chronic bleeding | ||
*Fecal incontinence | *[[Fecal incontinence]] | ||
====Complications due to surgery==== | ====Complications due to surgery==== | ||
| Line 32: | Line 32: | ||
===Prognosis=== | ===Prognosis=== | ||
*Prognosis is excellent. | *Prognosis is excellent. | ||
*Most cases respond well to non surgical procedures as rubber band ligation (recurrence rate is 30 -50%) after 5 years, however 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> | *Most cases respond well to non surgical procedures as [[rubber band ligation]] (recurrence rate is 30 -50%) after 5 years, however 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. | *The difference in recurrence rate is more pronounced with grade III hemorrhoids. | ||
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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 progress to develop 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
- If left untreated, hemorrhoids may progress to develop strangulation, thrombosis or infection.
- The main reasons for seeking delayed advise are as follows:
- Myths about the surgical treatment
- Postoperative pain
- Fear of incontinence after surgery
Complications
Most common complications
- Strangulation: 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.
- 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 is excellent.
- Most cases respond well to non surgical procedures as rubber band ligation (recurrence rate is 30 -50%) after 5 years, however recurrence rate is much less with surgical hemorrhoidectomy (2-5% after 5 years).[1][2]
- The difference in recurrence rate is more pronounced with grade III hemorrhoids.
References
- ↑ 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.
- ↑ 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.