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<sup>3</sup> Exam: viz inspect anus @ rest/straining, digital exam. Dx hemorrhoids by hx, exam. Lab tests almost never helpful. If there is bleeding, source often requires confirmation by endoscopic studies [SR/M]. Hemorrhoid-pattern bleeding (painless bleed w/ BM) mandates at least sig to r/o other bleed source. If ≥50 yo or if suggestive FHx, may be occasion for entire colon eval, usually by colonoscopy.<br><br>
<sup>4</sup> Cochrane review showed fiber’s benefit on prolapse, bleeding. Laxatives have limited role in initial tx. Astringent enema for sx relief has intuitive appeal.
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<sup>5</sup> Band ligation via rigid anoscope or retroflexed endoscope w/ ligation attachment. Ligation is reasonable 1st-line for 3rd-degree. Ligation is probably tx of choice for 2nd-degree. Suction-positioning less pain/bleed than forceps, yet both acceptable. Complications: pain, bleeding, thrombosis of ext hemorrhoids, vasovagal sx; life-threatening septic complications vanishingly rare. Infrared coag and sclero can tx bleeding hemorrhoids too small to ligate.
<sup>4</sup> Cochrane review showed fiber’s benefit on prolapse, bleeding. Laxatives have limited role in initial tx. Astringent enema for sx relief has intuitive appeal.
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<sup>5</sup> Band ligation via rigid anoscope or retroflexed endoscope w/ ligation attachment. Ligation is reasonable 1st-line for 3rd-degree. Ligation is probably tx of choice for 2nd-degree. Suction-positioning less pain/bleed than forceps, yet both acceptable. Complications: pain, bleeding, thrombosis of ext hemorrhoids, vasovagal sx; life-threatening septic complications vanishingly rare. Infrared coag and sclero can tx bleeding hemorrhoids too small to ligate.
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