Abstract
Hemorrhoids are a common anorectal condition characterized by bleeding, thrombosis, and prolapse. Initial treatment is usually focused on nonoperative interventions. Behavior modifications including sitz baths, regular exercise, consuming a low-fat diet, avoidance of excessive time on the toilet, and minimizing constipating medications may provide symptomatic relief. Oral fiber supplementation is safe and highly effective. A variety of nonsurgical ablative treatments exist, including rubber band ligation, injection sclerotherapy, and infrared photocoagulation; each of which offers unique advantages. Patients presenting with thrombosed external hemorrhoids and 48–72h of symptoms usually benefit from excision of the hemorrhoid. More invasive options aimed at ablation of hemorrhoids are reserved for patients with persistent symptoms or higher grade hemorrhoids.
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