A new treatment option for grade II and IV hemorrhoids.

October 2004 799 Hemorrhoids represent one of the most common colorectal complaints heard by family physicians. Each year approximately 10.5 million Americans experience hemorrhoidal symptoms; one fourth of those patients consult a physician. The most common symptom of internal hemorrhoids is bright red blood that covers the stool or appears on toilet paper or in the toilet bowl. Other symptoms include irritation of the skin around the anus; pain, swelling, or a hard lump around the anus; hemorrhoidal protrusion; and mucous discharge. Excessive rubbing or cleaning around the anus may exacerbate symptoms and even cause a vicious cycle of irritation, bleeding, and itching termed pruritus ani. Hemorrhoids also may thrombose, causing severe pain. More than half of men and women aged 50 years and older will develop hemorrhoidal symptoms throughout their lifetime. Hemorrhoidal symptoms also tend to flare up during pregnancy, when hormonal changes and the pressure of the fetus cause the hemorrhoidal vessels to enlarge. The likelihood of hemorrhoidal disease increases with age. By age 30, the anal support structure diminishes in function. This microscopic evidence, along with increased sphincter tone, may contribute to the progression of hemorrhoids. Although hemorrhoidal symptoms may subside after several days, they most often return, causing long-lasting discomfort and pain. Many affected persons—particularly those with severe hemorrhoids—suffer in silence for years before seeking treatment. Fortunately, only about 10% of patients have symptoms severe enough to require surgery. Glenn S. Parker, MD, FACS, FASCRS Chief, Division of Colon and Rectal Surgery, and Director, Gastrointestinal Oncology, Jersey Shore University Medical Center