Hemorrhoids and rectal internal mucosal prolapse: one or two conditions? A national survey

The surgical modalities for the treatment of hemorrhoids are quite numerous due to the rapid diffusion of new surgical techniques and to the different approaches to the pathophysiology of the disease by the proctologists. Stapled hemorrhoidopexy, one of the most recent surgical options proposed, emphasizes the role of rectal internal mucosal prolapse (RIMP) as the main cause of the disease. We performed a national survey among the most important proctologists on this particular clinical condition, in order to better define the indications for the surgical treatment of hemorrhoids. A questionnaire concerning the main clinical features of RIMP was mailed to 84 coloproctology centers. Two-thirds of the 41 proctologists who responded found RIMP in a minority of patients with hemorrhoids, whereas only one-third found RIMP in more than half of their patients. A circumferential RIMP was identified by only 10% of the surgeons, whereas a coincidence between pre- and postoperative diagnoses of this condition was possible in half of proctologists' patients. RIMP is not frequently associated with hemorrhoids. Therefore, it is unlikely to be a cause of hemorrhoidal disease, and many surgeons still recognize it as a difficult clinical condition to define.