Office evaluation and treatment of hemorrhoids

Surgical hemorrhoidectomy should be reserved for grade IV hemorrhoids and for grade III lesions that do not respond to other procedures.

This is an approximate rather than a rigid approach, and the final decision will depend on the physician’s technical training, the patient’s preferences, clinical circumstances, and local resources.

Prognosis: 90% require no surgery

Hemorrhoids are generally a chronic problem and tend to worsen with time. According to a retrospective cohort study, most patients will have several episodes during their lives; however, it can be considered a benign disorder, and approximately 90% of patients will not require surgery to alleviate their symptoms (SOR: B).⁴¹

It is worth noting that 26% of patients who require a hemorrhoidectomy may have a recurrence, and 11% will need further treatment.³⁹ Similarly, approximately half of those who undergo office procedures may require further treatment or surgery in 5 to 10 years.^42,43

ACKNOWLEDGMENTS

We thank E. Thompson for help in editing this manuscript and J. A. Ferrus and A. Hervas for their clinical comments. Dr Alonso-Coello holds a postgraduate research fellowship at the Instituto Carlos III, Spanish Ministry of Health, Spain.

Corresponding author
Pablo Alonso-Coello, MD, Ibero-american Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Sant Antoni Mª Claret 171, 08041 Barcelona, Spain. E-mail: palonso@cochrane.es.