Updates in the Management Of hemorrhoid

Abstract

Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They affect millions of people around the world, and represent a major medical and socioeconomic problem. Internal hemorrhoids classified into four stages according to severity. (Grad I, II, III, and IV),upon it Therapeutic treatment of hemorrhoids ranges from dietary and lifestyle modification to radical surgery, depending on degree and severity of symptoms. Initial therapy usually began by Fiber supplement, Lifestyle modification, as sitz-birth, plenty fluids intake, avoid straining and constipation… these help improvement of symptoms. Non-operative treatments are not fully effective, in particular those of topical or pharmacological approach. Hence, improvements in our understanding of the pathophysiology of hemorrhoids are needed to prompt the development of novel and innovative methods for the treatment of hemorrhoids. A variety of office-based (Sclerotherap, Rubber band ligation, Infrared coagulation, Cryotherapy…..) treatment options are available for the treatment of internal hemorrhoids. All are directed at producing fixation of the down ward displaced hemorrhoidal cushion into a more normal, proximal position. The choice of therapy may depend on surgeon preference and experience, equipment availability, patient medical comorbidities, and patient preference.