[Hemorrhoids: recognition and current therapeutic possibilities]

Up to 5% of the patients of a general practitioner have terminal bowel disease, most frequently hemorrhoids. Any patient who presents with ano-rectal discomfort or anal blood losses should undergo thorough proctologic examination including rectoscopy. Digital palpation is insufficient as only 10% of rectal carcinomas can be reached. The treatment of hemorrhoids should be started by instructing the patient on anal hygiene, to be followed only then by symptomatic application of creams or suppositories. If these symptomatic measures fail, treatment by injections is indicated. This method may be complicated by localized or extensive necrosis of the rectal mucosa, the cause of which is assumed to be an immunologic event resembling the Arthus phenomenon in which bacterial or possibly pharmacologic substances may act as antigens. Therefore, a method of provoking coagulation without using foreign substances was sought. Thermocoagulation by the infrared coagulator appears to be a suitable method: first experience tends show equal efficacy with coagulation by injection treatment. Prolapsing hemorrhoids are still treated by barron ligation. The precise management of each therapeutic approach is described.