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Objective Patients experiencing hemorrhoids or fissures may overlook other gastrointestinal (GI) symptoms, assuming that they are linked solely to their existing condition. However, colon cancer, often asymptomatic, can coincide with benign pathologies detected during colonoscopy. This study investigates the prevalence of colorectal cancer (CRC) in patients undergoing lower GI endoscopy for hemorrhoids and elucidates the correlation between cancer and benign pathologies identified during colonoscopy. Highlighting its potential to reveal hidden cancers emphasizes the critical role of colonoscopy in comprehensive health care. Methods The primary objective was to thoroughly investigate the prevalence of CRC in patients who underwent lower GI endoscopy for hemorrhoids. A comprehensive analysis was conducted using a dataset spanning 7 years of lower GI endoscopy. The main focus of this investigation was to determine the incidence of cancer. Additionally, a meticulous examination of accompanying benign diagnoses was performed to provide a comprehensive evaluation. Results The study cohort, comprising 6,268 patients, revealed a noteworthy coexistence of malignancies with common conditions. The revelation was of paramount significance that the total number of malignant cases within this cohort was 440. Polyps emerged as the most frequently observed condition, constituting 55.2% (n = 243) of the cases. Diverticulosis was present in 6.6% (n : 29) of cases, while ulcerative colitis was detected in 8% (n : 2) of cases. Hemorrhoids were identified in 20.7% (n : 91) of cases. The findings indicated a substantial association between these common conditions and malignancy. Specifically, it was discovered that approximately 1 in 22 individuals with hemorrhoids, 1 in 52 individuals with fissures, and 1 in 5.7 individuals with polyps were diagnosed with malignancy. Conclusion This study highlights the pivotal role of colonoscopy in uncovering hidden cancers, especially in patients with hemorrhoids. The findings emphasize the significance of doctors and patients prioritizing colonoscopy, as it allows for early detection and intervention for potential malignancies, even in the presence of hemorrhoids. [ABSTRACT FROM AUTHOR]

Objectives: Upper gastrointestinal bleeding (GIB) in patients has been well-characterized in liver cirrhosis but studies on lower GIB are limited. The clinical characteristics, management and outcomes in patients with and without liver cirrhosis was compared to determine the overall features of GIB in patients with liver cirrhosis compared with non-cirrhotics. Methods: A retrospective study on cirrhotics hospitalized for GIB 2010–2021, matched with control group of non-cirrhotics (1:4) for upper vs. lower GIB. Patients with overt bleeding leading to hospitalization were included. Results: Overall, 396 patients had cirrhosis, 267 (67%) men, median age 62, alcoholic etiology 177/396 (45%), median MELD 12 (range 6–32). Overall 102 cirrhotics had GIB, matched with 391 non-cirrhotics. Overall 87 (85%) cirrhotic patients had upper and 15% lower GIB. Compared to non-cirrhotics, the cause of GIB was more commonly acute variceal bleeding (AVB) (42% vs. 1%), hemorrhoids 40% vs. 6% (p = 0.002), less commonly gastric ulcer 13% vs. 31% (p < 0.001), duodenal ulcer 9% vs. 29% (p < 0.001), 5% of cirrhotics used NSAIDs vs. 26% of controls (p < 0.001). Rebleeding occurred in 14% of cirrhotics vs. 3% in controls (p < 0.001). Only one cirrhotic patient (1%) died from GIB vs. 0.8% of controls within 45 days. Overall mortality 45 days after hospitalization was 10% in cirrhotics vs. 5% in controls (p < 0.001) Conclusions: Bleeding from gastric and duodenal ulcers were less common in cirrhotics than in controls. Bleeding from hemorrhoids was more common in cirrhotics. Mortality due to GIB was low in both groups but overall mortality was significantly higher in cirrhotics. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion There is no universally accepted treatment consensus for haemorrhoids, and thus, management has been individualized all over the world. This study was conducted to assess a global view of how surgeons manage haemorrhoids.The research panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) developed a voluntary, anonymous questionnaire evaluating surgeons' experience, volume and treatment approaches to haemorrhoids. The 44 multiple‐choice questionnaire was available for one month via the ISUCRS email database and the social media platforms Viber and WhatsApp.The survey was completed by 1005 surgeons from 103 countries; 931 (92.6%) were in active practice, 819 (81.5%) were between 30 and 60 years of age, and 822 (81.8%) were male. Detailed patient history (92.9%), perineal inspection (91.2%), and digital rectal examination (91.1%) were the most common assessment methods. For internal haemorrhoids, 924 (91.9%) of participants graded them I–IV, with the degree of haemorrhoids being the most important factor considered to determine the treatment approach (76.3%). The most common nonprocedural/conservative treatment consisted of increased daily fibre intake (86.9%), increased water intake (82.7%), and normalization of bowel habits/toilet training (74.4%). Conservative treatment was the first‐line treatment for symptomatic first (92.5%), second (72.4%) and third (47.3%) degree haemorrhoids; however, surgery was the first‐line treatment for symptomatic fourth degree haemorrhoids (77.6%). Rubber band ligation was the second‐line treatment in first (50.7%) and second (47.2%) degree haemorrhoids, whereas surgery was the second‐line treatment in third (82.9%) and fourth (16.7%) degree symptomatic haemorrhoids. Rubber band ligation was performed in the office by 645(64.2%) of the participants. The most common surgical procedure performed for haemorrhoids was an excisional haemorrhoidectomy for both internal (87.1%) and external (89.7%) haemorrhoids – with 716 (71.2%) of participants removing 1, 2 or 3 sectors as necessary.Although there is no global haemorrhoidal treatment consensus, there are many practice similarities among the different cultures, resources, volume and experience of surgeons around the world. With additional studies, a consensus statement could potentially be developed. [ABSTRACT FROM AUTHOR]

The present study sought to understand how participants in r/hemorrhoid used three coping strategies to improve their health and wellbeing. Drawing upon Shame Resilience Theory (SRT), the typology of social support, and the classification of humor styles, a theory-driven approach to qualitative analysis resulted in the identification of the following themes: Belongingness (building authentic connections with others), Affirmation (asserting the value of own experiences), Safety (feeling able to express emotions and needs), and Efficacy (exchanging information and advice for recovery). The study presents a coping model (BASE) that can inform research on communication patterns in contexts beyond other health conditions. Practical implications are derived from users’ psychological distress and their reliance on diagnostics and treatment advice from peers, offering directions for supporting individuals with hemorrhoids. [ABSTRACT FROM AUTHOR]

Background and Aim. It is preferred that the management of internal hemorrhoids necessitates minimally invasive modality, high efficacy, less complication and feasibility in hospital with availability of endoscopy. This study aimed to evaluate the efficacy and safety of endoscopic band ligation (EBL) for bleeding grade III internal hemorrhoids in an evidence-based case report. Methods. A 50-year-old male patient with hematoschezia and anal pain was diagnosed as grade III bleeding internal hemorrhoid. Non-surgical management was preferred. The physician urged to provide the evidence regarding the safety and efficacy of endoscopic band ligation, compared to other modalities. A search was conducted on PubMed and Cochrane databases based on clinical query, with keywords “endoscopic band ligation AND internal hemorrhoids”. The inclusion criteria were meta-analysis, systematic review and randomized clinical trial, and written in English. The critical appraisal was performed for validity, importance and applicability. Results. Of 18 studies, only 2 studies suited the criteria. Compared to bipolar electrocoagulation (BPEC), EBL had significantly higher success rate in controlling bleeding and reducing the grade of hemorrhoids. In comparison with band ligation with rigid proctoscope (BL-RP), EBL was associated with higher success rate, lesser treatment sessions and earlier symptom control. Mild complications and symptomatic recurrence were comparable among EBL, BPEC and BL-RP. Conclusion. Endoscopic band ligation is effective and safe for bleeding grade III internal hemorrhoids. It is feasible procedure in primary referral hospital. [ABSTRACT FROM AUTHOR]

Aim: Hemorrhoids are difficult to treat. Multiple treatment options are available, supported by heterogeneous evidence. In our study, we aimed to analyze laser therapy’s clinical outcomes and effectiveness. Material and Method: Our study was conducted on 1096 patients who underwent Hemorrhoidal Laser Procedure (HeLP) and were diagnosed with grade II and III hemorrhoids in our general surgery clinic between 2018 and 2021. The patients pre- and post-operative clinical data were obtained from patient files, electronic records, and telephone interviews. Results: Bleeding and urinary retention were the most common complications in the early period. In the long term, the anal fissure was found to be the most common complication. We detected hemorrhoidal diseases 1.25 times more frequently in males. The patients presented to our clinic with the most common complaints of bleeding and hemorrhoidal syndrome. Conclusion: The use of laser therapy is an appropriate procedure for grade II and grade III hemorrhoids that do not respond to conservative approaches, which require minimal analgesic use, less need for wound care and very short duration of pain and discomfort, with high patient satisfaction. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the efficacy and safety of individualized homeopathic medicines (IHMs) in treating hemorrhoids compared with placebo. Design: This is a double-blind, randomized (1:1), two parallel arms, placebo-controlled trial. Setting: The trial was conducted at the surgery outpatient department of the State National Homoeopathic Medical College and Hospital, Lucknow, Uttar Pradesh, India. Subjects: Patients were 140 women and men, aged between 18 and 65 years, with a diagnosis of primary hemorrhoids grades I–III for at least 3 months. Excluded were the patients with grade IV hemorrhoids, anal fissure, and fistula, hypertrophic anal papillae, inflammatory bowel disease, coagulation disorders, rectal malignancies, obstructed portal circulation, patients requiring immediate surgical intervention, and vulnerable samples. Interventions: Patients were randomized to Group 1 (n = 70; IHMs plus concomitant care; verum) and Group 2 (n = 70; placebos plus concomitant care; control). Outcome measures: Primary—the anorectal symptom severity and quality-of-life (ARSSQoL) questionnaire, and secondary—the EuroQol 5-dimensions 5-levels (EQ-5D-5L) questionnaire and EQ visual analogue scale (VAS); all of them were measured at baseline, and every month, up to 3 months. Results: Out of the 140 randomized patients, 122 were protocol compliant. Intention-to-treat sample (n = 140) was analyzed. The level of significance was set at p < 0.05 two tailed. Statistically significant between-group differences were elicited in the ARSSQoL total (Mann–Whitney U [MWU]: 1227.0, p < 0.001) and EQ-5D-5L VAS (MWU: 1228.0, p = 0.001) favoring homeopathy against placebos. Sulfur was the most frequently prescribed medicine. No harm or serious adverse events were reported from either of the groups. Conclusions: IHMs demonstrated superior results over placebo in the short-term treatment of hemorrhoids of grades I–III. The findings are promising, but need to be substantiated by further phase 3 trials. Clinical Trial Registration Number: CTRI/2020/03/024342. [ABSTRACT FROM AUTHOR]

Background: Hemorrhoidectomy is a common procedure used to treat symptomatic hemorrhoids. However, the necessity and cost‐effectiveness of routinely conducting histopathological analysis on excised tissue samples are uncertain. Methods: A systematic review was conducted using MEDLINE and EMBASE up to December 2023 for studies assessing the histopathological outcomes of hemorrhoidectomy specimens. Meta‐analysis was performed on articles with combinable results to determine the pooled proportions of cancer and anal intraepithelial neoplasia (AIN) using the random effects model. Results: From 2974 initial search results, 12 studies were included in the review, with 48,365 resected specimens from hemorrhoidectomy. Among these, there were 11 retrospective studies and one prospective study. A meta‐analysis of 11 studies revealed that the prevalence of anal cancer was low, at 0.13% (95% CI: 0.05%–0.31%). The prevalence of anal cancer and AIN combined was 1.16% (95% CI: 0.53%–2.52%). Conclusion: This literature review estimated the probability of malignancy detection in hemorrhoid specimens sent for histopathological evaluation. The low incidence of malignant findings implies that routine analysis of hemorrhoidectomy samples may not be cost‐effective. However, existing studies have yet to establish definitive risk factors for abnormal histological diagnoses to aid in the selection of specimens for selective histopathology. [ABSTRACT FROM AUTHOR]

Endoscopic submucosal dissection (ESD) is a curative treatment for laterally spreading tumors (LSTs). However, the outcomes of ESD for LSTs with hemorrhoids remain largely unknown. Our study aimed to evaluate the usefulness of ESD in managing LSTs with hemorrhoids. We retrospectively collected 418 consecutive LST patients treated with ESD between 2011 and 2023. A retrospective comparative analysis was conducted. There were 85 patients included in the hemorrhoids group and 333 patients included in the other group. The en-bloc resection rate, R0 resection rate, and curative resection rate were comparable in these two groups (p > 0.05). The LSTs with hemorrhoids have a significantly higher intraoperative bleeding rate during ESD when compared to the other group (12.9% vs. 5.4%, p = 0.028). Rates of intraoperative perforation and anal pain in the hemorrhoid group were significantly higher than those in the no-hemorrhoid group (2.4% vs. 0%, p = 0.041; 9.4% vs.0.6%, p < 0.001; respectively). Moreover, most of the related manifestations caused by hemorrhoids were relieved to various degrees after ESD. ESD is a safe and effective treatment strategy for LSTs with hemorrhoids. A multi-center and prospective study should be conducted in the future to validate our results. [ABSTRACT FROM AUTHOR]

Background: Hemorrhoids are common conditions at or around the anus, to which numerous people suffer worldwide. Previous research has suggested that microbes may play a role in the development of hemorrhoids, and the origins of these microbes have been preliminarily investigated. However, no detailed research on the microbes related to hemorrhoid patients has been conducted. This work aims to provide an initial investigation into the microbes related to hemorrhoid patients with high quality whole genome sequencing. Methods: Forty-nine bacterial strains were isolated from seven hemorrhoid patients. Third-generation nanopore sequencing was performed to obtain high quality whole genome sequences. The presence of plasmids, particularly new plasmids, along with antibiotic resistance genes, was investigated for these strains. Phylogenetic analysis and genome comparisons were performed. Results: Out of the 31 plasmids found in the strains, 15 new plasmids that have not been observed previously were discovered. Further structural analysis revealed new multidrug-resistant conjugative plasmids, virulent plasmids, and small, high-copy mobile plasmids that may play significant functional roles. These plasmids were found to harbor numerous integrases, transposases, and recombinases, suggesting their ability to quickly obtain genes to change functions. Analysis of antibiotic resistance genes revealed the presence of antibiotic resistant-integrons. Together with the surprising number of new plasmids identified, as well as the finding of transmission and modification events for plasmids in this work, we came to the suggestion that plasmids play a major role in genetic plasticity. Conclusion: This study reveals that the diversity of plasmids in human-associated microbes has been underestimated. With the decreasing cost of whole-genome sequencing, monitoring plasmids deserves increased attention in future surveillance efforts. [ABSTRACT FROM AUTHOR]

Background: Laser Hemorrhoidoplasty (LHP) is a minimally invasive surgical option for the management of hemorrhoidal disease that has been increasingly adopted by surgeons over the last decade. Two wavelengths; 980 nm and 1470 nm have been employed in LHP. However, no data exist comparing the effects of these two wavelengths for this indication. This systematic review investigates both wavelengths for the management of hemorrhoids via the LHP procedure. Methods: This systematic analysis and meta-analysis was performed following the PICOS and PRISMA guidelines. A systematic research of MEDLINE, Scopus, Clinicaltrials.gov, Embase, Cochrane Central Register of Controlled Trials, CENTRAL and Google Scholar databases from inception until March 2024 was performed. Results: Overall, 19 studies including seven randomized control trials (RCT) and 12 non-randomized control trials with a total of 2492 patients were included in this systematic review and meta-analysis. The duration of LHP with both wavelengths was significantly shorter compared to open hemorrhoidectomy, postoperative pain and the rate of postoperative complications were significantly lower following LHP. There was no statistically significant difference in the rate of recurrence between LHP with the 980-nm wavelength and open hemorrhoidectomy. However, LHP with 1470-nm wavelength resulted in significantly higher recurrence rate compared to hemorrhoidectomy. Conclusion: Although no direct studies have compared the two wavelengths used in LHP, the outcomes of LHP seem to be independent of the wavelength used. Both wavelengths, when correctly used provide similar results, which are mostly better compared to open hemorrhoidectomy in terms of postoperative complications and postoperative pain, but not in terms of recurrence, where at least for the 1470-nm wavelength, LHP seems to show a higher recurrence rate when compared to open hemorrhoidectomy. Although a direct comparison of both wavelengths was not possible, technical issues regarding number of shots and energy per pile represent relevant parameters for recurrence after LHP. [ABSTRACT FROM AUTHOR]

Observational studies have reported an association between inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), and hemorrhoids (HEM). However, the presence of a causal relationship within this observed association remains to be confirmed. Consequently, we utilized the Mendelian randomization (MR) method to assess the causal effects of IBD on hemorrhoids. We validated the association between IBD and hemorrhoids in humans based on genome-wide association studies (GWAS) data. To investigate the causal relationship between IBD and hemorrhoids, we performed a two-sample Mendelian randomization study using training and validation sets. The genetic variation data for IBD, CD, UC, and hemorrhoids were derived from published genome-wide association studies (GWAS) of individuals of European. Two-sample Mendelian randomization and Multivariable Mendelian randomization (MVMR) were employed to determine the causal relationship between IBD (CD or UC) and hemorrhoids. Genetically predicted overall IBD was positively associated with hemorrhoids risk, with ORs of 1.02 (95% CIs 1.01–1.03, P = 4.39 × 10−4) and 1.02 (95% CIs 1.01–1.03, P = 4.99 × 10−5) in the training and validation sets, respectively. Furthermore, we found that CD was positively associated with hemorrhoids risk, with ORs of 1.02 (95% CIs 1.01–1.03, P = 4.12 × 10−6) and 1.02 (95% CIs 1.01–1.02, P = 3.78 × 10−5) for CD in the training and validation sets, respectively. In addition, we found that UC in the training set was positively associated with hemorrhoids risk (ORs 1.02, 95% CIs 1.01–1.03, P = 4.65 × 10−3), while no significant causal relationship between UC and hemorrhoids was shown in the validation set (P > 0.05). However, after MVMR adjustment, UC in the training set was not associated with an increased risk of hemorrhoids. Our study showed that there is a causal relationship between CD and hemorrhoids, which may suggest that clinicians need to prevent the occurrence of hemorrhoids in CD patients. [ABSTRACT FROM AUTHOR]

The aim of the present study was to analyze the cumulative incidence of depression diagnosis in patients with hemorrhoids and to evaluate the association between hemorrhoids and subsequent depression diagnosis. This retrospective cohort study was based on electronic medical records from the Disease Analyzer database (IQVIA) and included 87,264 individuals with hemorrhoids (mean age: 54.2 years; 42% women) and 87,264 propensity score-matched individuals without hemorrhoids in 1284 general practices in Germany between January 2005 and December 2021. Univariable Cox regression analysis was conducted to assess the association between hemorrhoids and depression. After up to 10 years of follow-up, 21.4% of patients with hemorrhoids versus 16.3% of the matched cohort (p < 0.001) were diagnosed with depression. There was a significant association between hemorrhoids and a subsequent diagnosis of depression (HR: 1.32; 95% CI: 1.28–1.37), which was confirmed in age- and sex-stratified analyses. The association was stronger with increasing degree of hemorrhoids, from HR: 1.29 (95% CI: 1.15–1.45) for Grade 1 to HR: 1.73 (95% CI: 1.11–2.69) for Grade 4 compared to no hemorrhoids. The present study provides compelling evidence of an association between hemorrhoids and subsequent depression. Addressing the mental health of individuals with hemorrhoids may not only improve their overall well-being but could also lead to better treatment outcomes for the primary condition. [ABSTRACT FROM AUTHOR]

Background: Hemorrhoid is very common ano rectal disease causing painless bleeding after defecation. Hemorrhoidectomy is still the most effective surgical treatment for hemorrhoidal disease, but it is, however, associated with complications such as pain in post-operative period. Aim of this study: is to evaluate to break the “vicious circle” of “pain–sphincteric spasm–pain” with the postoperative use of self-mechanical anal dilation. Materials and Methods: 30 patients undergoing hemorrhoidectomy as suffering from hemorroids were divided randomly in two groups by odd & even method, one group was assigned as dilator group where self-mechanical 33 mm Anal Dilator for 15 mins was used for a period of 02 weeks and in another group no anal dilator used although both had fibre diet amd laxative with sitz bath in post-operative period. Pain, oedema, discharge, bleeding and incontinence was observed on Ist, 3rd, 7th and 15th day. Results: 15 Patients who had undergone self-mechanical anal dilator showed less pain compaired to no dilator group (P<0.05). Bleeding, discharge and oedema was significantly low in both group, faecal incontinence was present in dilator group for 7 days but disappeared on 15th day(P=050). Conclusion: This prospective study confirms that self-mechanical anal dilatation reduce pain after haemorrhoidectomy. No faecal incontinence noticed. [ABSTRACT FROM AUTHOR]

Background: Laser hemorrhoidoplasty has demonstrated significant therapeutic effectiveness. To diminish postoperative bleeding and enhance overall outcomes, we have additionally adopted suture ligating the feeding vessels. This study aimed to understand the treatment outcomes and any associated complications. Methods: This study comprised patients with symptomatic grade II–III hemorrhoids who underwent laser hemorrhoidoplasty with feeding vessel suture ligation and Milligan–Morgan hemorrhoidectomy between 1 September 2020, and 31 August 2022. Surgical-related details, postoperative pain, discomfort after discharge, hemorrhoid recurrence, and any complications were collected from inpatient records, outpatient follow-ups, and telephone interviews. Initially, we will analyze the distinctions between the laser group and the traditional group, followed by an investigation into complications and satisfaction within the laser surgery subgroup. Results: The study included 323 patients, with 173 undergoing laser hemorrhoidoplasty (LHP) and 150 undergoing Milligan–Morgan hemorrhoidectomy. Regarding pain assessment, the LHP group exhibited superior performance compared to traditional surgery at postoperative 4 h, before discharge, and during the first and second outpatient visits, with statistically significant differences. Additionally, the LHP group had a lower rate of urinary retention and experienced significantly less pain, with statistically significant differences. Conclusions: Laser hemorrhoidoplasty with feeding vessels suture ligation has been shown to reduce postoperative pain and appears to be a promising minimally invasive treatment option for symptomatic grade II and III hemorrhoids. [ABSTRACT FROM AUTHOR]

In their consultations, family physicians are regularly confronted with complaints in the anal area. Anal bleeding or pain, pruritus ani, and perianal hematoma are common problems that cause considerable discomfort to those affected. Adequate clinical skills for diagnosis and treatment of these conditions are therefore necessary for high-quality patient care, as is knowledge of potential red flags. [ABSTRACT FROM AUTHOR]

Background and Objectives: Hemorrhoids are defined as swollen veins in the anus and lower rectum. Hemorrhoids are a common medical problem and have a negative impact on people’s lives. The drugs that are available on the market are limited, and therefore, the objective of the present research is to develop and evaluate a lidocaine and nitroglycerin ointment combination for enhanced external hemorrhoid treatment. Materials and Methods: Five formulations of 0.1% lidocaine and 0.1% nitroglycerin ointments (F1-F5) were developed using hydrocarbon bases (B1 and B2), hydrophilic petrolatum B3, hydrophilic B4, and emulsifying base B5. Different physicochemical parameters were conducted to evaluate the quality of the studied formulations. Results: Cracking was observed for F1 and F2 and phase transitions were noticed for F4 and F5. While, the hydrophilic petrolatum base formulation F3 showed the best physical stability up to one month with high uniformity with a drug content of 107.5% and a calibration curve R=0.9999. Docking study confirmed the activity of lidocaine and nitroglycerin towards hemorrhoids through conventional hydrogen bonds with target proteins 6s3a and 6t3w, respectively. F3 was tested by nine patients who suffered from external hemorrhoids for seven days. Patients reported a decrease in hemorrhoid grain sizes with excellent tolerability. Conclusion: The developed single formulation of two different drugs, lidocaine and nitroglycerin, has synergistic action and is well-tolerated treatment option for external hemorrhoids, as it not only decreases the hemorrhoid symptoms (pain and itchy) but also eliminates the side effects like headache that arise when the drugs are administered alone. [ABSTRACT FROM AUTHOR]

This retrospective investigation aimed to assess the frequency and demography of hemorrhoids in Kabul, Afghanistan. Materials and Methods: This study was conducted at Jamhuriat Hospital in Kabul, Afghanistan. Two hundred and fifty-two patients who were diagnosed with hemorrhoids were included. All pertinent demographic data were collected from the medical records and analyzed using IBM SPSS Statistics 25. Results: Males composed 83.7% of the patients, and 32.9% were aged 30– 40 years. A lower socioeconomic status was common (61.1%). Bleeding, prolapse, and pain were frequent symptoms. Surgical management was common for third- and fourth-degree hemorrhoids (51.6%). Conclusion: This study found a high prevalence of hemorrhoids among males (83.7%) and low-income individuals (61.1%), highlighting the need for further research into risk factors for delayed presentation. [ABSTRACT FROM AUTHOR]

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

Abstract Observational studies have reported an association between inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), and hemorrhoids (HEM). However, the presence of a causal relationship within this observed association remains to be confirmed. Consequently, we utilized the Mendelian randomization (MR) method to assess the causal effects of IBD on hemorrhoids. We validated the association between IBD and hemorrhoids in humans based on genome-wide association studies (GWAS) data. To investigate the causal relationship between IBD and hemorrhoids, we performed a two-sample Mendelian randomization study using training and validation sets. The genetic variation data for IBD, CD, UC, and hemorrhoids were derived from published genome-wide association studies (GWAS) of individuals of European. Two-sample Mendelian randomization and Multivariable Mendelian randomization (MVMR) were employed to determine the causal relationship between IBD (CD or UC) and hemorrhoids. Genetically predicted overall IBD was positively associated with hemorrhoids risk, with ORs of 1.02 (95% CIs 1.01–1.03, P = 4.39 × 10−4) and 1.02 (95% CIs 1.01–1.03, P = 4.99 × 10−5) in the training and validation sets, respectively. Furthermore, we found that CD was positively associated with hemorrhoids risk, with ORs of 1.02 (95% CIs 1.01–1.03, P = 4.12 × 10−6) and 1.02 (95% CIs 1.01–1.02, P = 3.78 × 10−5) for CD in the training and validation sets, respectively. In addition, we found that UC in the training set was positively associated with hemorrhoids risk (ORs 1.02, 95% CIs 1.01–1.03, P = 4.65 × 10−3), while no significant causal relationship between UC and hemorrhoids was shown in the validation set (P > 0.05). However, after MVMR adjustment, UC in the training set was not associated with an increased risk of hemorrhoids. Our study showed that there is a causal relationship between CD and hemorrhoids, which may suggest that clinicians need to prevent the occurrence of hemorrhoids in CD patients.

Background: The symptoms of hemorrhoids has a wide spectrum that ranges from bleeding per rectum, itching, prolapse of the hemorrhoidal cushions, thrombosis leading to pain and discomfort, incontinence especially of fluids and mucous discharge. But for surgical management, hemorrhoidectomy is more sustainable in symptom control and has been considered as gold standard. Rubber band ligation has been the most popular amongst non-surgical interventions because of its effectiveness, minimal complication rate and shorter recover period compared to operative procedures. The present study aimed at determining the efficacy and safety of rubber banding ligation procedure versus the standard hemorrhoidectomy for second degree hemorrhoids. Methods: A prospective randomised comparative study was conducted at Department of Surgery, Indira Gandhi Medical College Hospital, Puducherry for 18 months after getting institutional ethical committee clearance. A total no. of 74 cases of 2nd degree hemorrhoids were divided into two groups A (open hemorrhoidectomy) and B (banding) by simple randomization technique of 37 each. A detailed history & examination including per rectal and Proctoscopy examination was done of each patient and the data entered in the pro forma. The description of data was expressed in the form of mean±SD for quantitative data, while frequency and proportion for qualitative data. Results: Totally male patients represented 57% compared to female with 43% 78% of the patients who underwent banding did not have any immediate post-operative complications while only 4 persons reported pain and bleeding post-operatively compared to 12 patients reporting bleeding and 11 patients reporting pain after hemorrhoidectomy. The duration of hospital stay post procedures was found to be lesser in banding group compared to hemorrhoidectomy group with p value being statistically highly significant (p