title: Manual reduction in acute haemorrhoids.
abstract: OBJECTIVE
  In prolapsed internal hemorrhoids exposed outside the anus, manually reducing the prolapse with 48 hours of commencement of anal pain, decreased the progression of thrombosis. The aim of our study was to evaluate the effects of manual reduction of the inflamed piles hemorrhoids.
  
  
  METHODS
  Eleven patients, 7 males and 4 pregnant females (in early post partum) with an average age of 34 years ± 8 (range 23- 52) were enrolled with anal pain cause by haemorrhoidal congestion, but prior to full blown thrombosis. Patients underwent a manual reduction of the external prolapsed haemorrhoidal plexus. In the 48 hours following the procedure, patients were instructed on how to insert any prolapsed hemorrhoid (piles) themselves. Pain intensity was measured using the visual analog scale (VAS) at time of consultation and then 10 days after the reduction.
  
  
  RESULTS
  At day 10 following treatment we observed a statistically significant reduction in anal swelling (11 vs 1, n° pzt; p = 0.001), anal pain (11 vs 2, n° pzt; p = 0.001) and VAS score (8.6 ± 0.7 vs 0.4 ± 1.2; p = 0.001). Two patients (18%) underwent surgical haemorrhoidectomy sec. Milligan Morgan and 1 patient (9%) underwent excision of thrombosed external hemorrhoids. 73% of patients did not require surgery.
  
  
  CONCLUSIONS
  Manual reduction of the prolapsed piles outside the anus decreased pain immediately and it also allows postponement of surgery or any other treatment.
authors.affiliation: Dipartimenti di 1Chirurgia Generale e Specialistica, "Paride Stefanini", Policlinico Umberto I - Sapienza Università di Roma.
authors.forename: F
authors.initials: F
authors.lastname: Gaj
authors.affiliation: Medicina Interna e Specialità Mediche, "Sapienza" Università di Roma.
authors.forename: L
authors.initials: L
authors.lastname: Candeloro
authors.affiliation: Medicina Interna e Specialità Mediche, "Sapienza" Università di Roma.
authors.forename: I
authors.initials: I
authors.lastname: Biviano
mesh_terms: D000328:Adult; D005260:Female; D006484:Hemorrhoids / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011247:Pregnancy
keywords: Hemorrhoid pile; Manual reduction; VAS scale