title: Timing and necessity of a flexible sigmoidoscopy in patients with symptoms suggestive of haemorrhoids.
abstract: OBJECTIVE
  This study was performed to determine the probability of finding additional pathology, requiring treatment or follow-up, in patients referred with symptoms suggestive of haemorrhoids. Secondly, to determine, at what age a flexible sigmoidoscopy should be performed in these patients.
  
  
  METHODS
  All patients referred for the treatment of haemorrhoids over a period of 5 years were prospectively included in a database. Data included patient characteristics, clinical information, histopathological analysis and the sigmoidoscopy results.
  
  
  RESULTS
  Haemorrhoids were present in 961 (95.6%) of 1005 patients. Of these patients, 692 (72.0%) patients were free from any additional pathology, 161 (16%) patients had diverticulosis, in 15 (1.5%) patients the sigmoidoscopy showed signs of colitis, 116 (11.5%) patients had polyps and a malignancy was present in eight (0.8%) patients. In the age group between 30-40 and 40-50, the presence of additional pathology increased significantly (P < 0.05). No malignancies were found under the age of 40.
  
  
  CONCLUSIONS
  The vast majority of patients referred for the treatment and analysis of haemorrhoids were free from any additional pathology. But, over the age of 40, the incidence of additional pathology increased significantly. Therefore, we suggest that a flexible sigmoidoscopy should be performed in all patients over the age of 40, with clinical signs of haemorrhoids.
authors.affiliation: Department of Surgery, Maaslandziekenhuis, Sittard, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Vening
authors.forename: E M
authors.initials: EM
authors.lastname: Willigendael
authors.forename: E K M
authors.initials: EK
authors.lastname: Tjeertes
authors.forename: K W E
authors.initials: KW
authors.lastname: Hulsewé
authors.forename: A G M
authors.initials: AG
authors.lastname: Hoofwijk
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003108:Colonic Diseases / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006484:Hemorrhoids / Q000150:complications* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D012812:Sigmoidoscopy