title: A prospective randomized trial of consultant-led injection sclerotherapy compared with nurse practitioner-led noninvasive interventions in the management of patients with first and second degree haemorrhoids.
abstract: OBJECTIVE
  To determine whether nurse practitioner (NP)-led advice in relation to bowel and defecatory habits in hemorrhoidal disease is as effective as local invasive treatment (sclerotherapy) in the management of patients with symptomatic 1st and 2nd degree haemorrhoids, with respect to both alleviation of presenting symptoms and relapse rate, and patients' understanding of their condition.
  
  
  METHODS
  In a prospective randomized trial, 25 patients with bleeding haemorrhoids were allocated to receive either standard medical injection sclerotherapy (Group 1, n=13) or NP-led advice, information and bowel habit retraining (Group 2, n=12). Bulking agents were offered, when deemed appropriate, to patients in both groups. Treatment was administered by two clinicians only. Patients were assessed at 8 weeks, 4 months and finally at 6 months post treatment and any symptoms present were graded.
  
  
  RESULTS
  At 6 months, symptomatic improvement was similar in both groups (mean range 3 points) with a patient expected to get better with a good degree of confidence (C.I: 2-4 points). However those patients in Group 2 would be expected to have a slightly better minimum level of improvement (GP 1 P=0.004 GP 2 P=0.0005). At six months, there was no statistical difference between the two groups with regard to the patient's perception of the amount of information given, the clarity of the explanation, and the ability of the patient to understand and discuss their problem. In relation to understanding the cause of their problem patients in Group 2 felt they had a higher level of understanding of the cause of their problem (U=13, NA=7, NB=10, P=0.05) and felt more able to prevent their problem returning (U=12, NA=7, NB=10, P=0.05).
  
  
  CONCLUSIONS
  A bulking agent and Nurse led education, advice and bowel habit retraining is as effective in reducing the incidence of bleeding from 1st and 2nd degree haemorrhoids as injection sclerotherapy. Patients who consult a NP with symptomatic 1st and 2nd degree haemorrhoids feel more empowered in the long term. Non-invasive bowel retraining methods should be offered as an alternative to more traditional, invasive treatments for patients with symptomatic early hemorrhoidal disease.
authors.affiliation: Surgical Nurse Specialist Department, Homerton Hospital, London, UK. Thersa.porrett@homerton-hospital.thenhs.com
authors.forename: T R
authors.initials: TR
authors.lastname: Porrett
authors.forename: P J
authors.initials: PJ
authors.lastname: Lunniss