Hemorrhoids natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, hemorrhoids may | 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=== | ||
*If left untreated, hemorrhoids may | *If left untreated, hemorrhoids may lead to [[strangulation]], [[thrombosis]], or [[infection]]. | ||
*The main reasons for seeking | *The main reasons for a delay in seeking medical advice are as follows: | ||
:*Myths about the surgical treatment | :*Myths about the surgical treatment | ||
:*Postoperative pain | :*Postoperative pain | ||
| Line 16: | Line 15: | ||
===Complications=== | ===Complications=== | ||
====Most common complications==== | ====Most common complications==== | ||
*[[Strangulation|Strangualtion]]: The prolapsed | *[[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 | *[[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==== | ||
*Anal stenosis | *Anal [[stenosis]] | ||
*Wound dehisence | *Wound dehisence | ||
*Wound sepsis | *Wound [[sepsis]] | ||
*[[Fistula]] formation | *[[Fistula]] formation | ||
===Prognosis=== | ===Prognosis=== | ||
*The prognosis is excellent. | *The prognosis is excellent. | ||
*Most cases respond well to non surgical procedures as [[rubber band ligation]] (recurrence rate is 30 -50% | *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. | *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 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
- If left untreated, hemorrhoids may lead to strangulation, thrombosis, or infection.
- The main reasons for a delay in seeking medical advice are as follows:
- Myths about the surgical treatment
- Postoperative pain
- Fear of incontinence after surgery[1]
Complications
Most common complications
- 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
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
- ↑ 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.