Symptoms govern treatment

doi:10.1136/bmj.39500.442384.1F

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Simon B Middleton, consultant colorectal surgeon,
Richard E Lovegrove, specialist registrar in general surgery,
Howard Reece-Smith, consultant general surgeon

¹Royal Berkshire Hospital, Reading RG1 5AN

simon.middleton{at}royalberkshire.nhs.uk

Acheson and Scholefield reviewed the management of haemorrhoids.1 At our centre, we have adopted an approach whereby symptoms govern the therapeutic decision.

For many patients, bleeding is the principal symptom, and we have used Doppler guided haemorrhoidal artery ligation (DGHAL) since 2004 in those whose condition has not improved after injection of oily phenol in the outpatient clinic. …