title: Hemorrhoids and fistulas: new solutions to old problems.
abstract: Symptoms thought related to hemorrhoids must be carefully considered before intervention. The first line of therapy for any hemorrhoidal complaint remains conservative management with increased fluid and fiber intake and appropriate modification of toileting behavior. Bleeding in grades 1 and 2 hemorrhoids that does not respond to this can be satisfactorily and safely managed with office-based therapies; some grade 3 hemorrhoids would also respond to this, though more treatment sessions would likely be required. Operative therapy is the best choice for management of persistently symptomatic grade 2 disease and for grades 3 and 4 symptomatic hemorrhoids as well. With proper patient selection and preparation, along with a familiarity with instrumentation and techniques, good results can be obtained with newer operative interventions for internal hemorrhoids. Outcomes must always be compared with those obtained with classic excisional hemorrhoidectomy.
authors.forename: Jan
authors.initials: J
authors.lastname: Rakinic
authors.forename: Venkateswara Prasad
authors.initials: VP
authors.lastname: Poola
mesh_terms: D001003:Anal Canal / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D017679:Cryotherapy; D004035:Diet Therapy; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D061865:Hemorrhoidectomy / Q000379:methods; D006484:Hemorrhoids / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008026:Ligation; D011183:Postoperative Complications; D012003:Rectal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D015911:Sclerotherapy; D013524:Surgical Flaps; D013630:Tampons, Surgical; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D015718:Fibrin Tissue Adhesive; D054368:Laxatives; D014014:Tissue Adhesives