Current medical, anoscopic, endoscopic, and surgical treatments for bleeding internal hemorrhoids

Abstract

Internal hemorrhoids are extremely common in adults and are the most frequent cause of self-limited hematochezia in ambulatory adults. Most patients with gastrointestinal bleeding from internal hemorrhoids have bright red blood per rectum that stops and is not associated with anemia. However, approximately 15% to 20% of patients with bleeding internal hemorrhoids have more severe bleeding that requires hospitalization and transfusion for severe anemia. In a CURE Hemostasis Research Group study of patients with severe hematochezia, internal hemorrhoids represented the second most common colorectal cause of severe hematochezia. Bleeding internal hemorrhoids are most effectively diagnosed by slotted anoscopy; however, in adults, other colonic lesions need to be excluded by colonoscopy. Endoscopic and anoscopic techniques for treatment of bleeding internal hemorrhoids include sclerotherapy, banding, direct current probe, infrared coagulator, bipolar probe, and heater probe. Endoscopic diagnosis, treatment techniques, results, and complications are presented in this report, and medical and surgical treatments are discussed.