| [ Summary ] |
Hemorrhoidal diseases are classified into the categories of internal or external. Internal hemorrhoids have traditionally been divided into four degrees, depending on the extent of prolapse. The first degree consists of those which do not descend out of the anal canal on straining. The second degree consists of those which protrude out of the anal canal on straining and return into the anal canal again immediately after straining. The third degree consists of those which descend to the exterior only on straining or defecation and are able to be replaced digitally into the anal canal. The fourth degree consists of those which are permanently outside the anal verge, and can not be replaced into the anal canal. According to the principles of internal hemorrhoid management, first and second degree hemorrhoids are treated with conservative therapies using suppositories or ointments, oral administration of vasotopic drugs, and by modifying defecation habits. The operations of hemorrohoidectomy, should be performed for third and fourth degree conditions. Other treatments including sclerotherapy and rubber-band ligation have been popular for a considerable time. Recently, new treatments consisting of ALTA injection therapy and stapled hemorrhoidopexy using a circular stapler (PPH) have gradually come into use. External piles are treated with conservative therapy, in principle. However, in cases with the presence of severe pain or much larger piles, the operation, to evacuate clots, should be performed. |