Editorials

How to treat haemorrhoids

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7261.582 (Published 09 September 2000) Cite this as: BMJ 2000;321:582

Prevention is best; haemorrhoidectomy needs skilled operators

  1. Giuseppe Brisinda (gbrisin@tin.it), surgeon
  1. Surgical Unit, San Salvatore Hospital, Viale G Verdi 27, 61100 Pesaro, Italy

    Haemorrhoids and their symptoms are one of the most common afflictions in the Western world.14 They can occur at any age and can affect both women and men. Because the presence of haemorrhoidal tissue is normal—it acts as a compressible lining which allows the anus to close completely—disease should be thought of as haemorrhoidal tissue that causes significant symptoms. 1 2 Unfortunately, haemorrhoids tend to get worse over time, and disease should be treated as soon as it occurs.

    Haemorrhoids cushion sinusoids, and bleeding occurs from presinusoidal arterioles.2 The main cushions lie at the left lateral, right anterolateral, and right posterolateral portions of the anal canal. Secondary cushions may be present. Proposed aetiological factors include constipation, prolonged straining, derangement of the internal anal sphincter, and pregnancy. Haemorrhoids may be caused by more than one factor. Despite being examined in several studies, the pathogenesis remains unclear. 1 2 Haemorrhoids can be either internal or external, and patients may have both types.14 External haemorrhoids occur below the dentate line and are generally painful. When …

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