Hemorrhoids: diagnostics and treatment. Literature review


Martyna Bakutytė1, Simona Ripkauskaitė1, Vilius Ripkauskas1

1Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania



Hemorrhoids are common disease of the anorectal zone. The main factor, which can cause hemorrhoids is increased intraabdominal pressure (for example: persistent constipation, low fiber food consumption, shortage of liquids, pregnancy, obesity, connective tissue disease). The exact epidemiology of this disease is unknown. Hemorrhoid knots are classified according to localization and degree of fallout. They can be internal, external or mixed. Hemorrhoids can be acute or chronic. The diagnosis of hemorrhoids is based on medical history and physical examination. Internal hemorrhoids manifest themselves in bleeding after defecation and discomfort in the anus. External hemorrhoids are painful, especially if thrombosis occurs. External hemorrhoid knots or proliferating internal knots are visible during perineal and anal examinatio. Digital examination can show palpable masses, soft tissues or fluctuation, however internal hemorrhoid knots are commonly not palpable, unless they arbe big or prolabating. Anoscopy is an effective way to visualize internal hemorrhoid knots. The treatment of hemarrhoids can be conservative or surgical. The conservative hemorrhoid knots treatment consists of diet with higher fiber intak, bigger consumption of liquids, warm water baths and osmotic preparations. 0,4% nitroglycerin ointment, nifedipine or botulinum toxin injection into the anal sphincter are remedies used to relief symptoms. 1-20 internal hemorrhoid knots are treated on an outpatient basis and therefore  Elastic Baron’s rings and infrared coagulation are used for surgical treatment. 3-40 hemorrhoid knots are removed surgically by hemorrhoid excision. Hemorrhoidopexy and hemorrhoidal artery ligation are alternative surgical treatment methods. This article reviews hemorrhoids epidemiology, clinical signs, diagnosis and treatment.

Keywords: hemorrhoids, trombosis, bleeding.