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Adequate dietary fiber supplement and TONE can help avoid surgery in most patients with advanced hemorrhoids
Pankaj Garg1,2, Pratiksha Singh3
1Colorectal Surgery Division, Department of General Surgery, Indus Super Specialty Hospital, Mohali, Punjab, India - drgargpankaj@yahoo.com.
Insights
Correcting deranged defecation habits (DDH) with the TONE method and fiber supplements significantly improves advanced hemorrhoids, reducing bleeding and preventing surgery in most patients.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Preventive Medicine
Background:
- Hemorrhoids often stem from three key deranged defecation habits (DDH): increased straining, prolonged defecation time, and frequent bowel movements.
- These habits contribute to the development, progression, and bleeding of hemorrhoids.
- The TONE mnemonic (Time, Occasion, No Straining, Enough fiber) offers a structured approach to correcting DDH.
Purpose of the Study:
- To evaluate the efficacy of the TONE method combined with fiber supplementation in managing advanced hemorrhoids (grades III and IV).
- To assess improvements in prolapse, reduction in bleeding episodes, and patient satisfaction.
- To determine the potential for preventing surgical intervention in patients with advanced hemorrhoids.
Main Methods:
- Patients with advanced hemorrhoids (grades III-IV) were enrolled and received counseling on the TONE method and fiber supplementation (psyllium husk).
- Treatment goals included limiting defecation time to three minutes, achieving once-daily bowel movements, avoiding straining, and ensuring adequate fiber intake.
- Outcomes measured included prolapse improvement, bleeding episode frequency, and patient satisfaction levels over a follow-up period.
Main Results:
- Out of 102 patients, 85 completed the study. Significant improvements were observed: 68.2% reported high satisfaction, prolapse improved in 56.5%, and bleeding episodes decreased from 71.8% to 29.4% (P<0.0001).
- Progression of prolapse was halted in 25.9% of patients.
- Only 12.9% of patients required subsequent surgery, indicating a high success rate for the conservative management.
Conclusions:
- Combining adequate fiber supplementation with the TONE method effectively corrects DDH in patients with advanced hemorrhoids.
- This approach successfully halts hemorrhoid progression and reduces bleeding episodes, thereby preventing the need for surgery in a majority of cases.
- The TONE method provides a viable, non-surgical management strategy for advanced hemorrhoids.
Background:
The root cause of hemorrhoids resides in three deranged defecation habits (DDH), namely increased straining, prolonged defecation-time, and frequent bowel-motions. These DDH are responsible for the development of new hemorrhoids, progression of existing one and hemorrhoidal rupture (bleeding). DDH can be corrected with the help of the "TONE" mnemonic. TONE entails specifying exact treatment goals: T, three minutes at defecation; O, once-a-day defecation frequency; N, no straining during passing motions; E, enough fiber. TONE can be implemented by proper counseling and by prescribing fiber supplement appropriately (5-6 teaspoonfuls of psyllium husk with 600 mL of water daily. Corrected DDH would prevent the progression of hemorrhoids and bleeding episodes. An office procedure may be done to further downgrade the hemorrhoids.
Methods:
Patients with advanced hemorrhoids (grades III and IV) who were referred for surgery were prescribed fiber supplement and were counseled to follow TONE. The outcome parameters evaluated were improvement in prolapse, bleeding episodes, satisfaction levels.
Results:
A total of 102 patients (75 males and 10 females, mean age 46.0±13.5 years, 17 lost to follow-up) with advanced hemorrhoids (41 with early grade III, 38 with late grade III, and 6 with grade IV) were included in the study. All patients had symptoms of prolapsed hemorrhoids and bleeding episodes were present in 71.8% (61/85) of patients. After the follow-up of 40 (12-96) months, 68.2% (58/85) patients were highly satisfied, 12.9% (11/85) were moderately satisfied and 18.9% (16/85) were not satisfied with treatment. Prolapse improved in 56.5% (48/85), did not progress over time in 25.9 (22/85) and continued to progress in 4.7% (4/85) patients. 12.9% (11/85) underwent operation for hemorrhoids. Bleeding episodes decreased from 71.8% (61/85) to 29.4% (25/85) (P<0.0001).
Conclusions:
Adequate fiber supplement combined with the TONE method can correct DDH, thus stopping the progression of hemorrhoids and bleeding, and preventing surgery in most patients with advanced hemorrhoids.
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