HEMORRHOIDS - 07/09/11

Doi : 10.1016/S0095-4543(05)70100-7

Joy N. Hussain, MD ^{^{*
Cairns Base Hospital, Cairns, Far North Queensland, Australia}}

Résumé

Hemorrhoids, or enlarged veins in the anal area, represent one of the most frequent and familiar anorectal problems seen in the primary care office setting. There are estimates that hemorrhoids occur in up to 80% to 90% of the US population.^{6Has P.A., Has G.P., Schmaltz S., et al. Prevalence of hemorrhoids Dis Colon Rectum 1983 ; 26 : 435

Cliquez ici pour aller à la section Références, 23Zainea G., Randall G., Norman D.A., et al. Office treatment of hemorrhoids Procedures For Primary Care Physicians. St. Louis: Mosby-Year Book, Inc (1994).
929

Cliquez ici pour aller à la section Références} Because the term hemorrhoids is so often misused by patients to describe a multitude of other anorectal problems contributing to perianal pain and bleeding, the actual prevalence based on epidemiologic studies is more in the range of 40%.^{4Gazet J.C., Redding W., Rickett J.W.S. The prevalence of haemorrhoids Proc R Soc Med 1970 ; 63 : 78

Cliquez ici pour aller à la section Références} The prevalence of hemorrhoids is equal between men and women, but men are more likely to seek treatment.^{8Janicke D.M., Pundt M.R. Anorectal Disorders Emerg Med Clin North Am 1996 ; 14 : 757 [cross-ref]

Cliquez ici pour aller à la section Références} The prevalence of hemorrhoids also increases with age until the seventh decade, at which point there appears to be a slight decline.^{8Janicke D.M., Pundt M.R. Anorectal Disorders Emerg Med Clin North Am 1996 ; 14 : 757 [cross-ref]

Cliquez ici pour aller à la section Références, 11Johanson J.F., Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiological study Gastroenterology 1990 ; 98 : 380

Cliquez ici pour aller à la section Références} Pregnancy is a common predisposing risk factor for the development of hemorrhoids.^{13Medich D.S., Fazio V.W. Hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy Surg Clin North Am 1995 ; 75 : 77

Cliquez ici pour aller à la section Références}

When appropriately diagnosed, most hemorrhoids can be treated successfully in the outpatient setting by the primary care provider. Careful clinical assessment is required to ensure that more significant bowel disease is not missed in the process. This article summarizes the current pathogenesis, identification, differential diagnoses, and appropriate treatment options for hemorrhoids and clarifies indications for surgical intervention.

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Plan

ANATOMY AND PATHOPHYSIOLOGY

ORIGIN

HISTORY, CLINICAL PRESENTATION AND DIAGNOSIS

PATIENT EXAMINATION

DIFFERENTIAL DIAGNOSIS

CLASSIFICATION OF INTERNAL HEMORRHOIDS

TREATMENT

Internal Hemorrhoids

Thrombosed External Hemorrhoids

External Hemorrhoidal Skin Tags

CONCLUSION

Address reprint requests to Joy N. Hussain, MD, PO Box 470 H, Edge Hill, QLD 4870, Australia, e-mail: jhussain@iig.com.au
Adapted from Billingham RP: Hemorrhoids, anal fissure and anorectal abscess and fistula. In Rakel RB (ed): Conn's Current Therapy, 1998. Philadelphia, W.B. Saunders, 1998; with permission.