Modern management of hemorrhoids.

Hemorrhoids require therapy only when they cause symptoms. Early symptoms troubling the patient only occasionally are readily managed by dietary measures that increase the intake of fluids and fiber, such as bran, often supplemented by hydrophilic bulk-forming colloids, so that a bulky, soft stool is produced regularly. Rubber band ligation is the treatment of choice for small or moderate sized hemorrhoids with minimal prolapse, whether or not they bleed. Such bands should be applied to the mucosa at the anorectal junction and not directly to the hemorrhoidal tissue. Patients with large prolapsing or acutely thrombosed hemorrhoids are best managed by a closed type of hemorrhoidectomy. This technique is effective and safe and has great advantage with rapid healing and minimal postoperative care, which provides the patient with the maximum comfort. Complications are few and, in particular, anal stenosis or stricture is rare. Hemorrhoids occurring in association with other conditions require specific treatment only if they are responsible for symptoms in their own right, distinct from the associated condition. Other treatments discussed are effective but have particular disadvantages that make them unsuitable for routine use. Moreover, they offer no advances on the treatment regimens proposed.