Treatment Of Hemorrhoids Research Articles

Procto-Glyvenol© accelerates the natural healing process of wounds: a pre-clinical study.

Hemorrhoids are a common anorectal disease that causes pain, itching, and burning. The prevalence of hemorrhoids is estimated to be as high as 36% in the general population, with approximately 50% of individuals experiencing symptomatic hemorrhoids at least once in their life. Middle age, obesity, and pregnancy are risk factors. The combination of tribenoside and lidocaine (Procto-Glyvenol©, Recordati) has been used for decades to treat low-grade hemorrhoids, and its efficacy and safety are well supported by clinical experience. Tribenoside has been shown to have an anti-inflammatory effect, ameliorate the local microcirculation and vascular tone, and promote the healing of basement membrane. However, the molecular mechanism behind its wound-healing properties is still unclear. Human dermal fibroblasts were used to test the effect of tribenoside on cell proliferation, cell migration, and production of reactive oxygen species in vitro. Full-thickness excisional wound model in rats was used to test the wound-healing properties of Procto-Glyvenol© in vivo. Tribenoside has been found to increase the migration rate of fibroblasts in vitro and to improve the wound healing process by promoting re-epithelialization in rats. Furthermore, novel antioxidant activity of tribenoside has been reported, which may represent a further mechanism of action in wound healing. Procto-Glyvenol© improves the natural healing process of wounds by stimulating cell migration and protecting against the toxic effects of reactive oxygen species. Therefore, it may represent a first-line treatment for hemorrhoids, which are a significant medical and socioeconomic problem that can deteriorate the quality of life.

A comparative clinical study for haemostatic action of Lajjalu Lepa and Darvi Lepa in Raktarsha

Arsha is a disease afflicting mankind for thousands of years. In Ayurvedic literature, this disease is mentioned as one of the ‘Ashtamahagadas’[1] and difficult to cure. Nearly 45% of patients attending ano-rectal clinics suffer from the symptoms of Arsha. Vitiation of Doshas adversely affects the digestive fire resulting in Mandagni which in turn lead to constipation. Prolonged contacts of accumulated Mala or excretory material taint Gudavali resulting in Arshas.[2] Acharya Charaka explains Arsha as an abnormal fleshy growth at anorectal region whereas at other sites it is called as Adhimamsa.[3] In spite of progress in modern medicine, there is very little scope in terms of treatment of Hemorrhoids, Surgical techniques of performing hemorrhoidectomy are many and their complications such as pain, anal incontinence, stricture etc. are well known. All these modern surgical & Para surgical techniques are associated with post-operative complications which may be early complications such as hemorrhage, secondary infection etc., & late complications such as anal stricture. Anal incontinence, profuse watery discharge etc.,[4] Hence, in the present study a special emphasis will be made by selecting noninvasive, effective and economic therapeutic modality which has been explained with great details in ancient Ayurvedic Samhitas for the management of Arsha with different type of Lepa which is a painless simple procedure.

Essential of Graptophyllum pictum for the medical and dental purposes

Background: The use of plants for medicinal purposes continues to expand rapidly across the world. Up to 80% of the world's population is estimated to rely heavily on herbal medicines for their primary health care. Graptophyllum pictum leaves (GPL) have long been used as herbal medicine for several diseases or health conditions. However, until now, there have been only limited studies regarding laboratory experiments and the pharmacological effects of GPL. Purpose: To summarize the phytopharmacology aspect of GPL used for medical and dental purposes. Review(s): Based on the 36 articles included, GPL is widely used in medicine and dentistry, such as for treatment of hemorrhoids, periodontitis, and candidiasis, due to its anti-inflammatory, antioxidant, and antifungal properties. However, the current research study designs are still in vitro and in vivo experiments. Continuing experiments and clinical tests are needed to explore the essential use of the GPL. Conclusion: GPL can be used for medical and dental purposes due to its anti-inflammatory, antioxidant, antibacterial, and antifungal properties.

Evaluation of Laser Pile Surgery versus Ligasure Hemorrhoidectomy in Treatment of Hemorrhoids

Evaluation of Laser Pile Surgery versus Ligasure Hemorrhoidectomy in Treatment of Hemorrhoids

Influence of Solvents and Solvent Mixtures on the Content of Polyphenols and Antioxidant Activity of Capsella bursa-pastoris (L.) Medik. Extracts

Capsella bursa-pastoris (L.) Medik. (known as shepherd's purse) is a plant whose parts are used as medicine in herbal medicine. It is applicable as a medicine in the treatment of all forms of internal bleeding, for the treatment of hemorrhoids, excessive menstruation, but also for the usual stopping of nosebleeds. Through this research, the influence of organic solvents and their aqueous mixtures on the efficiency of polyphenol extraction and antioxidant activity was compared. The inhibition of free radicals was tested by the DPPH method, while the FRAP method was used to test the reduction potential. Analyzes have shown that water is the most effective solvent in the isolation of polyphenols from the aerial parts of shepherd's purse. Mixtures of organic solvents with water also showed high efficiency in the extraction of bioactive components, while the weakest results were obtained for extracts prepared in pure organic solvents.

Use of Hot Brine Solution as a Sitz Bath in the Treatment of Haemorrhoids- ACase Study

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A Prospective Study of Post-operative Complications Following Stapled Haemorrhoidectomy

Introduction: Haemorrhoids is one of the most common anorectal disorders. Stapled haemorrhoidectomy (SH) is newly developed method for the surgical management of Haemorrhoids. Objective: To evalute postoperative complications followed by Stapled haemorrhoidectomy. Methods: A prospective observational study was conducted among the patients with haemorroid those who got admitted in different surgery units in the department of surgery in Shaheed Suhrawardy Medical College Hospital, Dhaka from 01 December 2015 to 31 May 2016. A total of 60 patients were selected following convenient sampling technique. Data were collected by face to face interview using a structured questionnaire and check list. All completed questionnaires were validated manually and data were analyzed by using descriptive and inferential statistics with SPSS 19.0. Results: In this study, immediate complications (first week) were: bleeding (8.3%), urinary retention (5.0%), moderate pain (5.0%), pruritus (5.0%) and submucosal abscess (1.7%). The most common complication after 1 week was mild pain (8.3%), stenosis (5%), flatus incontinence, recurrence of hemorrhoids in 3.3% and bleeding was (3.3%). Recurrent hemorrhoids were treated by ligation in 40% and by Milligan-Morgan procedure in 32%. Anal stenoses were treated by dilatation in 55% and by anoplasty in 45%. It was revealed from study that among the patients treated with SH 21.6% had immediate complications followed by 24.3% had late complications. Conclusion: Prevention is the best treatment of haemorrhoids. Stapled haemorrhoidectomy is safe with many short-term benefits like less post-operative pain, early return from hospital and early return to their normal activities. Like other modalities it is also associated with a long-term risk of hemorrhoid recurrence and the symptom of prolapse. However, this method is well accepted and comfortable for the patients. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 57-60

A Case Report on the Clinical Efficacy of Kankayana Vati and Pilovos Ointment, A Novel Topical Agent, in the Management of Second-Degree Hemorrhoids

Haemorrhoids, caused by the inflammation and symptomatic enlargement of anal cushions, are a common pathological condition. The conventional medical treatment of haemorrhoids shares similarities with Arsoroga in Ayurveda, both in terms of etiology and clinical features. Kankayana Vati is a widely used internal medicine for haemorrhoids, although the dosage has not been explicitly specified. Additionally, a novel ointment, Pilovos, has been developed for local application to provide symptomatic relief. This case study explores the combined efficacy of Kankayana Vati (2 grams per day) and Pilovos ointment in the management of second-degree haemorrhoids in a 32-year-old male patient.

Prevalence, Characteristics, and Treatment of Hemorrhoids During Pregnancy: A Nationwide Population-Based Cohort Study in Taiwan.

Background: Hemorrhoids, a gastrointestinal tract disorder, are common during pregnancy. However, large-scale epidemiological studies on hemorrhoids during pregnancy are limited. Therefore, this study used analyzed data from a nationwide population-based database to investigate the prevalence, characteristics, and treatment of hemorrhoids in Taiwan. Materials and Methods: This retrospective population-based study used data from the National Health Insurance Research Database and Taiwan Birth Certificate Application to collect the medical records of women who were pregnant at any time during 2009-2018. Hemorrhoids was defined by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) (455. X) and International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) (K64.X, O22.4X) with related treatment. Results: We enrolled 1,608,804 deliveries in 1,070,708 women. The proportion of hemorrhoids increased with age in both primipara and multipara women. Of the pregnant women, 31% received oral medication, and 93.2% used the topical ointment to treat their hemorrhoids. Few patients (1.8%) required procedure or surgery during pregnancy, and 41.4% of those patients underwent procedure or surgery in their first trimester. The cumulative incidence of hemorrhoids during pregnancy was significantly higher in women with a history of hemorrhoids and those with multifetal pregnancies. No significant difference in the incidence of hemorrhoids was observed between multiparous and primiparous women. Conclusion: Women with a history of hemorrhoids or those carrying multiple fetuses had an increased risk of hemorrhoids during pregnancy. The most commonly used treatment for hemorrhoids during pregnancy was topical ointments, with only a small proportion (1.8%) of patients requiring procedure or surgery.

Laser Hemorrhoidoplasty Versus Ligasure Hemorrhoidectomy: A Comparative Analysis.

Background and objective Minimally invasive techniques in the surgical treatment of hemorrhoids have been gaining in popularity. Laser hemorrhoidoplasty (LHP) and LigaSure™(LigH; Medtronic, Dublin, Ireland)hemorrhoidectomy methods are the most recent innovative methods that are increasingly used. In this study, we aimed to compare the effectiveness of these two innovative techniques. Methods The data of patients who underwent LHP or LigH for grade III hemorrhoidal disease at our clinic between January 2022 and June 2023 were retrospectively analyzed. Postoperative pain levels, time to return to work or daily activities, complication rates, and recurrence rates of the treated patients were recorded. Results A total of 100 patients were included in the study. Of these, 48 patients had LHP surgery and 52had LigH surgery. The demographic characteristics of both groups were similar. The mean operation time was statistically significantly shorter inthe LHP group (p<0.001). The visual analog scale (VAS) scores on postoperative days one and seven were lower in favor of the LHP (2.4 ± 0.7 and 1.2 ± 0.9 vs. 6.2 ± 1.5 and 3.8 ± 1.3, respectively; p< 0.001). The median time to return to daily activity was 2.3(range: one to three) days in the LHP group and 4.6(range: 3-11)days in the LigH group (p<0.001). Recurrence was observed in 11 (22%) patients in the LHP group and in three (6%) patients in the LigH group (p<0.001). Conclusion Based on our findings, LHP is an effective procedure for the surgical treatment of hemorrhoidal disease as it is associated withless morbidity, less pain, early return to work, and acceptable recurrence rates.

Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients.

Hemorrhoidal disease (HD) is a chronic multifactorial disease. Increased abdominal pressure, along with hyperperfusion, neovascularization, overexpression of inflammatory mediators, and dysbiosis, contributes to the development of HD. The deterioration of the anchoring connective tissue with reduced collagen content and altered collagen ratios, dilatation of blood vessels and thrombosis, muscle injury, and inflammation gradually lead to clinically manifesting prolapse and bleeding from hemorrhoids. The associations of the ABO blood types with a disease have been investigated for the upper gastrointestinal tract only. This study aimed to evaluate HD clinical manifestations, surgeries carried out, and the status of prolapsed anorectal tissues by exploring the associations with the patients' ABO blood groups. Clinical and various morphological methods, combined with extensive bioinformatics, were used. The blood type 0, grade III and IV HD individuals constituted the largest group in a moderately-sized cohort of equally represented males and females studied and submitted to surgical treatment of hemorrhoids. There were significantly more complaints reported by HD females compared to males (p = 0.0094). The Longo technique appeared mostly used, and there were proportionally more surgeries performed below the dentate line for HD individuals with blood type 0 compared to other blood type patients (24% vs. 11%). HD males were found to present with significantly more often inflamed rectal mucosa (p < 0.05). Loosening and weakening of collagenous components of the rectal wall combined with vascular dilation and hemorrhage was found to differ in 0 blood type HD individuals compared to other types. HD males were demonstrated to develop the ruptures of vascular beds significantly more often when compared to HD females (p = 0.0165). Furthermore, 0 blood type HD males were significantly more often affected by a disease manifested with tissue hemorrhage compared to the 0 blood type HD females (p = 0.0081). Collectively, the local status of chronically injured anorectal tissue should be considered when applying surgical techniques. Future studies could include patients with HD grades I and II to gain a comprehensive understanding of the disease progression, allowing for a comparison of tissue changes at different disease stages.

Early Outcomes of Stapled Haemorrhoidopexy for 3RD Degree Haemorrhoids in Diabetic Patient

Background: Stapled haemorrhoidopexy is a newer modality representing a paradigm change in the treatment of haemorrhoids with better short-term outcomes, shorter operating times and less post-operative pain. Though short- term effects of stapled haemorrhoidopexy are well documented in general haemorrhoid patients, but till date, no study focused the outcome of diabetic patients. Aim of the Study: The aim of the study was to determine the short-term outcome of stapled haemorrhoidopexy in diabetic patients. Methods: This prospective observational study was conducted at the Department of Surgery in BIRDEM General Hospital, for one year of period following approval of this protocol. A total of 30 patients with diabetes mellitus and 3rd degree haemorrhoid was enrolled in this study. Written informed consent was ensured from each of the participants. A detailed history and thorough clinical examination were carried out in each patient. All patient underwent stapled haemorrhoidoplexy. Follow up was taken at 24 hours of operation, 14th POD, after 1 month, after 3 months and after 6 months. All information was recorded in separate case record form. After collection of all the required data, analysis was done by SPSS 23.0. Results: Mean age of the study participants was 45.53±3.91 (SD) years with a majority in 40-49 years of age. About 70% of the study population were male and 30% were female. Post-operative mean VAS score was 1.83±1.05 (SD) after 24 hours of operation and 0.60±0.89 after 2 weeks. About 66.7% patients experienced single episode of per-rectal bleeding after 24 hours of surgery, 20.7% had 2 episodes and 6.7% had 3 episodes. Mean hospital stay duration was 1.17±0.46 (SD) days. Average usual daily resumption of all patients was 6.90±2.37 (SD) days. Conclusion: The average age of the studied patients was 45 years with clear male predominance. short operative time, less post-operative pain, quicker return from hospital and early return to their normal activity was

Results of preoperative application of micronised purified flavonoid fraction as part of a multimodal analgesic regimen in anorectal surgery: a prospective, randomised, placebo-controlled, double-blind study

This study aims to assess the efficiency of micronised purified flavonoid fraction (MPFF) administration prior to open haemorrhoidectomy on postoperative pain severity reduction.Methods. The prospective clinical study involved patients with haemorrhoidal disease. Participants were randomly divided into two groups: the first one received 1000 mg of MPFF (Detralex®) 15 days before surgery, seven days after surgery, according to the acute haemorrhoid treatment scheme, and 1000 mg per day until 30 days after surgery; the second one received a placebo. The primary endpoint was the frequency of opioid intake.Results. The study included 182 participants (102 and 82 in the experimental and control group, respectively). Postoperative pain at rest and during defecation was significantly lower in the experimental group on days 6—9 postoperatively (p &lt; 0.05). The use of opioids and other NSAIDs after surgery did not differ between groups. There was no significant difference between groups in side effects frequency and time to return to the usual lifestyle. As for the quality of life, the control group had significantly higher levels of self-care difficulty, anxiety and lingering pain/discomfort, being more likely to suffer from other persistent complaints.Conclusion. The preoperative administration of MPFF as analgesia has demonstrated safety and efficacy, effectively reducing postoperative pain in anorectal surgery while avoiding an increase in side effects. Hence, it is recommended for routine implementation in patient care as an essential component of multimodal analgesia during anorectal surgery.

Croton Oil-induced Hemorrhoidal Rats: Evaluation of Anti-inflammatory Mediated Anti-hemorrhoidal Activity of Tridax procumbens Whole Plant

Background: Hemorrhoids are anorectal disorders characterized by dilation of rectal blood vessels, inflammation, and prolapse of the anal tissue. The disease affects both men and women equally. In consequence, the increasing prevalence of the disease needs potential agents with efficiency and low cost to support the treatment. Objective: The treatment of hemorrhoids in modern medicine is still found to be in its infancy, as there is no precise treatment for the specific disease. Tridax procumbens Linn (T. procumbens) belongs to the family Asteraceae. From the literature, the plant was found to have a traditional use for the treatment of hemorrhoids. Hence, the present research was focused on evaluating the antiinflammatory mediated anti-hemorrhoidal potential of ethanolic whole plant extract of T. procumbens (EWETP) in croton oil-induced hemorrhoidal rats. Methods: An in vitro study was conducted to evaluate the percentage inhibition of protein (egg albumin) denaturation by Tridax procumbens. This study determined the initial protective role of plant extracts against inflammatory proteins. An in vivo, anti-inflammatory-mediated anti-hemorrhoidal study was carried out on T. procumbens in various groups of croton oil-induced hemorrhoidal rats. Wistar albino rats were selected for the present research, and hemorrhoids were induced in experimental animals using a croton oil preparation containing 6% croton oil, deionised water, pyridine, and diethyl ether. Pilex ointment was taken as a reference drug in this study. Inflammation seems to be a major pathway for the progression of hemorrhoids. Hence, in the present research, Evans blue (EB) extravasation technique was applied to quantify inflammatory proteins. On the last day of the study, blood samples were drawn from experimental animals to analyse serum and blood for TNF- α, IL-6, and the percentage of neutrophils count. Recto anal coefficient was calculated to measure croton oil-induced rectal inflammation in animals. Histopathological studies were carried out separately on a second set of animals to identify the protective role of T.procumbens on rectal tissue cell histology. Molecular docking studies were carried out to rule out the possible interaction of plant phytoconstituents with the COX-2 enzyme. Results: Results showed that intra rectal application of croton oil preparation in albino rats developed hemorrhoids by elevating serum TNF-α and IL-6 in positive control group animals compared to normal group rats. Treatment of albino rats with T. procumbens at doses of 200 mg/kg and 400 mg/kg in groups IV and V has shown a significant reduction in serum TNF-α and IL-6. Furthermore, in the study, T. procumbens exhibited a significant dose-dependent reduction of EB dye extravasation in study animals. The study observations also revealed the inhibitory effect of plant extract on the blood percentage of neutrophils count and recto anal coefficient compared to the positive control group rats. Histopathological studies conducted on rectoanal tissues showed the presence of minimal rectal tissue changes in plant extract-treated group animals compared to positive control group rats. Molecular docking studies explored the possible interaction of phenolic compounds of plant extract with the COX enzyme. Conclusion: It was concluded that Tridax procumbens had a protective role against inflammatory mediators in hemorrhoids. In hemorrhoidal rats, ethanolic leaf extract was found to reduce the plasma percentage of neutrophils and other inflammatory cytokines, TNF-α, and IL-6. It could be used as a therapeutic anti-inflammatory mediated anti-hemorrhoidal agent.

Acute Symptomatic Seizure as the Manifestation of Camphor Ingestion, Prescribed for Hemorrhoids Treatment

Acute Symptomatic Seizure as the Manifestation of Camphor Ingestion, Prescribed for Hemorrhoids Treatment

Diagnosis and treatment of external hemorrhoids on an outpatient basis

Diagnosis and treatment of external hemorrhoids on an outpatient basis

Prevention of Inflammation Initiation on Acetic Acid-Induced Ulcerative Colitis in Rats by Malva nicaeensis All.

Aerial parts of Malva nicaeensis All. are preferred in the prevention and treatment of intestinal infections and hemorrhoids in Turkish traditional medicine. This study is planned to evaluate the pharmacological activity of M. nicaeensis extracts on rats with acetic acid-induced colitis. The plant material was subsequently extracted with n-hexane, ethanol, and water, respectively. All of these extracts were tested for efficacy in the acetic acid-induced rat colitis model. The aqueous and polysaccharide extracts regulated cytokine levels and antioxidant parameters. Furthermore, the aqueous extract in particular regulated myeloperoxidase and caspase-3 levels in this rat model. In addition, the polysaccharide-rich fraction was separated from the aqueous extract. The polysaccharide-rich fraction and aqueous extract regulated cytokine levels and antioxidant parameters. The aqueous extract also positively affected myeloperoxidase and caspase-3 levels. The phytochemical studies revealed that the aqueous extract had the highest phenolic content. In addition, the polysaccharide fraction was found to contain total sugars, sulfated groups, uronic acids, and total proteins in 78.4%, 0.9%, 1.5%, and 14.7%, respectively, and was rich in monosaccharide-type compounds, especially galactose (36.4%). M. nicaeensis was discovered to be a drug lead in the future treatment of irritable bowel diseases or as a complementary therapeutic agent that aided conventional treatments.

Catheter-directed hemorrhoidal embolization for rectal bleeding due to hemorrhoids (Goligher grade I-III): prospective outcomes from a Spanish emborrhoid registry.

To evaluate the safety and efficacy of catheter-directed hemorrhoidal embolization (CDHE) by microcoil embolization for rectal bleeding due to hemorrhoids classified as Goligher grade I-III. Eighty patients (62.5% males) with a mean age of 48 ± 9 years were recruited prospectively. All patients had symptomatic bleeding hemorrhoids. All patients were classified according to Goligher classification: grade I (13.7%), grade II (71.1%), grade III (15%), and no grade IV were recruited in this study. In all cases, microcoils were used to embolize the superior rectal artery(SRA), and microspheres if recurrence of bleeding occurred. Follow-up evaluation (1, 3, 6, and 12 months) included clinical examination and anoscopy. A questionnaire was conducted to determine improvement regarding bleeding, quality of life before, and the degree of patient satisfaction of each participant. Technical success was achieved in 100% of the cases. Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization. VAS and QL improved 4 points and 1.5 respectively after embolization. A total of 25/80 (31.3%) had a recurrence in rectal bleeding. Seventeen (21.3%) patients underwent a second embolization, and four patients (5%) were treated with open hemorrhoidectomy. No major complications were observed. Sixteen participants had minor complications. Subjective post-treatment symptom and QL surveys showed significant differences from the baseline survey. Likewise, the degree of satisfaction in the telephone survey at 12 months revealed a high degree of patient satisfaction (8.3±1.1). The present study demonstrates that CDHE is a feasible, well-tolerated, ambulatory, anal sphincter-sparing procedure for the treatment of internal hemorrhoids. CDHE is a simple procedure, well tolerated and accepted by patients, that preserves the anal sphincter and presents few complications when metal devices or microspheres are used as embolic agents. • The technical success rate of CDHE, defined as the closure of all the SRA in their distal segment, was achieved 100% of all patients. However, a second embolization treatment was required since 21.25% of the patients experienced rectal bleeding. • Overall, CDHE's safety profile is acceptable. After the procedure and 1 year of follow-up, no significant complications were observed. • Encouraging clinical outcomes have demonstrated CDHE in individuals with hemorrhoids and mild prolapse Goligher grades I-III with persistent rectal bleeding.

Awareness and Acceptance of Digital Rectal Examination for the Clinical Evaluation of Anorectal Conditions Among the Saudi Population: A Cross-Sectional Study.

Digital rectal examination (DRE) is an important diagnostic tool used by physicians to resolve several confusing clinical situations. The history and physical examination cannot be complete without performing a DRE. Any patient that presents with abdominal complaints (e.g., diarrhea, constipation, nausea, vomiting, abdominal or rectal pain, bleeding) needs a DREwhich isimportant for detecting warning signs of serious conditions that require further investigation and evaluation such as malignancies. Therefore, our aim was to assess and measure the awareness of the Saudi population regarding the importance and acceptance to perform DRE. This cross-sectional study was conducted in Riyadh, the capital city of Saudi Arabia, using an online survey between September 2022 and March 2023; the targeted participants were adults between the ages of 18 to 75. The study indicated that the general community awareness of DRE is low, with only 59.1% of participants having heard of DRE and 14.6% having undergone the procedure previously. The majority of individuals (60.9%) were willing to undergo DRE if a healthcare provider suggested it. Participants' knowledge of DRE's ability to detect various anorectal diseases varied. While the majority of individuals believed DRE could detect hemorrhoids, just 40.4% believed DRE could help detect colorectal cancer. Chronic constipation or diarrhea, feces-induced stretching, and prolonged sitting were the most oft-cited causes of hemorrhoids. Anemia was the most often reported consequence of hemorrhoids, followed by hypertension and diabetes. The significance of DRE as a screening tool for the early detection and prevention of anorectal problems, as well as the need for adequate care and treatment of hemorrhoids to prevent complications, are highlighted by these findings. Healthcare practitioners should actively recommend and provide information about DRE and other screening technologies, as well as address their patients' concerns and misconceptions.

Laser technology in proctological diseases: is it really the wave of the future?

Different types of lasers have been applied for various proctological conditions. We discuss about published articles regarding the application of lasers, with concern about evidence-based use of these techniques and technologies. We performed a literature search about laser treatments for proctological conditions. 55 studies were included for the final revision. Meta-analysis of data was not performed because of heterogeneity of study designs and outcome measures. A scoping review was performed. Laser treatments for hemorrhoids require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive. Studies are heterogeneous in design, endpoints, postoperative assessment, length of follow-up and outcome measures. Only 3 RCTs are available and only three studies evaluate long-term outcomes. FiLaC (fistula laser closure) was initially described in 2011 for the treatment of anal fistula. In the published studies the reported healing rates vary between 20 and 82%, and the ideal indication is yet to be defined. Studies with long-term follow-up are lacking. SiLaT (sinus laser treatment) applied the technology used for FiLaC to the treatment of pilonidal sinus disease. This technique had less perioperative pain and shorter hospital stay, but a lower primary healing rate when compared to traditional techniques. Available data is very limited, and no randomized trials are published to date. Laser assisted techniques are a viable, minimally invasive, but expensive option for the treatment of several proctological conditions. Further researches are needed to assess if patients could benefit of their use, and for what indication.