The Management of Hemorrhoids

This guideline offers evidence-based recommendations on the targeted levels of Clinical practice guidelines and provide healthcare professionals with practical guidance on the diagnosis and treatment of hemorrhoids.

·  We recommend performing a disease-specific history and physical examination emphasizing the degree and duration of symptoms and risk factors, (Strong Recommendation).

·  Complete endoscopic evaluation of the colon is recommended in select patients with symptomatic hemorrhoids and rectal bleeding, (Conditional Recommendation).

·  Medical therapy for hemorrhoids is preferred as it carries minimal harm and has the potential for symptomatic relief, (Conditional Recommendation).

·       Dietary and behavioral modifications are recommended as the primary first-line therapies for patients with symptomatic hemorrhoidal disease, (Strong Recommendation).

· Most patients with symptomatic grade I or II hemorrhoids and selected patients with grade III hemorrhoids refractory to conservative treatment can be effectively treated with office-based procedures. We recommend Haemorrhoid banding as an effective office-based treatment in these patients, (Strong Recommendation).

· We recommend against injection sclerotherapy for treatment of hemorrhoids and recommend RBL instead of it, (Strong Recommendation).

·   We recommend against infrared coagulation for treatment of hemorrhoids and recommend RBL instead of it, (Strong Recommendation).

· We recommend early surgical evacuation of thrombosed external hemorrhoids, (Conditional Recommendation).

· Excisional hemorrhoidectomy is recommended for patients with external hemorrhoids or patients with symptomatic combined internal and external hemorrhoids (grades III–IV), (Strong Recommendation).

· Doppler-guided hemorrhoid artery ligation may be recommended for patients with internal hemorrhoids, (Conditional Recommendation).

·  Stapled hemorrhoidopexy is not routinely recommended as a first-line surgical treatment for internal hemorrhoids given its marginal efficacy and significant risk, (Conditional Recommendation).

·  Laser haemorrhoidoplasty (LHP), if available, is recommended for patients with first-, second-, and third-degree haemorrhoids, seeking a minimally invasive option with potentially reduced postoperative pain and quicker recovery, (Conditional Recommendation).

·  Laser haemorrhoidoplasty (LHP) is not recommended for grade 4 haemorrhoids and haemorrhoidal prolapse, (Strong Recommendation).