Managing haemorrhoids

Abstract

Introduction Improvements in our understanding of the anatomy of haemorrhoids have prompted the development of new and innovative methods of treatment. Unfortunately confusion still exists among lay people and doctors, who misuse the terms haemorrhoids and piles to cover a variety of complaints. This has led to estimates of prevalence varying from 4.4% among adults in the United States to 36.4% in general practice in London.1 2 This article describes the pathogenesis of haemorrhoids and management strategies (fig 1). View larger version: In this window In a new window Fig 1 Suggested algorithm for management of haemorrhoids (dotted arrows indicate failure of initial treatment) Footnotes Contributors JHS wrote the section on surgery, and PJN wrote the rest of the article. PJN is the guarantor. Competing interests None declared. Extra references w1-w16 appear on bmj.com