Hemorrhoids natural history, complications and prognosis: Difference between revisions
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:*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<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> | ||
===Complications=== | ===Complications=== | ||
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*[[Strangulation|Strangualtion]]: The prolapsed hemorrhiods can be trapped outside the [[anal canal]] if the [[anal sphincter]] goes into [[spasm]]. This can lead to [[thrombosis]] of the hemorrhoids or cutting the blood supply to it. | *[[Strangulation|Strangualtion]]: The prolapsed hemorrhiods can be trapped outside the [[anal canal]] if the [[anal sphincter]] goes into [[spasm]]. This can lead to [[thrombosis]] of the hemorrhoids or cutting the blood supply to it. | ||
*[[Secondary infection]] and [[abscess]] formation | *[[Secondary infection]] and [[abscess]] formation | ||
*Hemorrhoid thrombosis | *Hemorrhoid [[thrombosis]] | ||
====Less common complications==== | ====Less common complications==== | ||
| Line 28: | Line 28: | ||
*Wound dehisence | *Wound dehisence | ||
*Wound sepsis | *Wound sepsis | ||
*Fistula formation | *[[Fistula]] formation | ||
===Prognosis=== | ===Prognosis=== | ||
* | *The 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[1]
Complications
Most common complications
- Strangualtion: The prolapsed hemorrhiods can be trapped outside the anal canal if the anal sphincter goes into spasm. This can lead to thrombosis of the hemorrhoids or cutting the blood supply to it.
- 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
- The 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).[2][3]
- The difference in recurrence rate is more pronounced with grade III hemorrhoids.
References
- ↑ 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.
- ↑ 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.