{ "slug": "how-far-to-push-hemorrhoids-back", "question": "Can you push a prolapsed hemorrhoid back in, and how do you do it safely?", "shortTitle": "Pushing a Prolapsed Hemorrhoid Back In", "clinicalQuestion": "In adults with a prolapsed (externally protruding) internal hemorrhoid, does manual digital reduction back into the anal canal safely relieve symptoms and reduce the risk of complications such as incarceration, strangulation, or thrombosis, compared with leaving it to reduce spontaneously or not reducing it?", "questionKind": "treatment", "pico": { "population": "Adults with a prolapsed internal hemorrhoid (grade III-IV) protruding outside the anus", "intervention": "Manual (digital) reduction of the prolapsed hemorrhoid back into the anal canal", "comparator": "No manual reduction; spontaneous reduction or usual supportive care", "outcomes": [ "Symptom relief (pain, swelling)", "Successful resolution of prolapse", "Incidence of incarceration or strangulation", "Incidence of thrombosis", "Need for emergency or urgent surgery", "Recurrence of prolapse within 3-12 months" ], "excludes": [] }, "category": "anorectal", "relatedConditions": [ "hemorrhoids", "rectal-prolapse", "hemorrhoid-thrombosis" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "No study has tested whether pushing a prolapsed hemorrhoid back in with your finger is safe or helps.", "detail": "The 12 related studies found look at drugs, injections, banding, and surgery for hemorrhoids, not the act of manually pushing a prolapsed hemorrhoid back in. The only report that actually describes someone doing this is a single case where it led to a serious infection in a person whose immune system was weakened by chemotherapy.", "studyIds": [ "pmid:42798126", "pmid:42067175", "pmid:37838461", "pmid:35552375" ] }, "strength": { "level": "very-low", "why": "The 12 human studies found measure a related question rather than this one, so they can only be read indirectly.", "override": null }, "direction": { "level": "not-studied", "why": "No study has measured this outcome in people with this condition.", "override": null, "signOff": null, "withheld": null }, "counts": { "recordsRetrieved": 1436, "recordsScreened": 200, "included": 20, "rcts": 2, "systematicReviews": 1, "observational": 6, "participants": 1673, "yearFrom": 2022, "yearTo": 2026, "registeredTrialsWithoutResults": 0, "direct": 0 }, "excluded": [], "outcomes": [ { "name": "Symptom relief (pain, swelling)", "status": "not-studied", "note": "No study measured pain or swelling relief specifically from pushing a prolapsed hemorrhoid back in. Trials of oral drugs and creams measured symptom scores for hemorrhoids generally, but that is a different question.", "studyIds": [] }, { "name": "Successful resolution of prolapse", "status": "not-studied", "note": "No study measured whether manual reduction successfully resolves a prolapse, or compared it with leaving the hemorrhoid to go back in on its own.", "studyIds": [] }, { "name": "Incidence of incarceration or strangulation", "status": "insufficient", "note": "One case report describes a serious complication (tissue erosion and infection) after someone pushed a prolapsed hemorrhoid back in, but this was a single person with a weakened immune system from cancer chemotherapy. No study counted how often incarceration or strangulation happens after manual reduction.", "studyIds": [ "pmid:42798126" ] }, { "name": "Incidence of thrombosis", "status": "not-studied", "note": "No study tracked whether manually pushing a hemorrhoid back in makes a blood clot (thrombosis) inside it more or less likely.", "studyIds": [] }, { "name": "Need for emergency or urgent surgery", "status": "not-studied", "note": "Reviews of anorectal emergencies describe when surgery becomes necessary, such as for gangrenous prolapse, but none tested whether manual reduction changes how often that happens.", "studyIds": [ "pmid:37838461" ] }, { "name": "Recurrence of prolapse within 3-12 months", "status": "not-studied", "note": "No study has tracked whether a hemorrhoid that is pushed back in is likely to prolapse again in the weeks or months afterward.", "studyIds": [] } ], "benefits": [], "limitations": [ { "text": "All of the studies found compare medical, injection, banding, or surgical treatments against each other. None of them study the simple act of pushing a prolapsed hemorrhoid back in with a finger.", "studyIds": [ "pmid:42067175", "pmid:41987169", "pmid:35552375" ] }, { "text": "The only report close to this question is a single case of a woman being treated for breast cancer, whose immune system was severely weakened by chemotherapy. She developed a severe infection with an eroded hemorrhoid, was treated with antibiotics, immune support, and multiple wound-care measures together, and recovered after 30 days. The case does not show whether the infection was caused by manual reduction, and it is not a planned safety study of the technique or representative of most people.", "studyIds": [ "pmid:42798126" ] }, { "text": "Most of the related studies are small, retrospective, or single case series, graded low or very low quality, so even the indirect information available is shaky.", "studyIds": [ "pmid:41987169", "pmid:41480327", "pmid:40922264", "pmid:39923169", "pmid:39563748" ] } ], "risks": [ { "text": "Reviews of anorectal emergencies note that a prolapse that cannot be reduced and becomes strangled or gangrenous needs emergency surgery, though no study tested whether manual reduction attempts help prevent or accidentally worsen this.", "studyIds": [ "pmid:37838461" ], "severity": "serious" } ], "whyPeopleTryIt": [ { "text": "It can stop the uncomfortable feeling of something sticking out or rubbing on clothing." }, { "text": "It feels like a fast fix that avoids an embarrassing trip to the doctor." }, { "text": "Online forums and home-remedy advice often suggest pushing it back in." }, { "text": "It can temporarily reduce the visible bulge and the pressure that comes with it." } ], "keyStudies": [ "pmid:42798126", "pmid:42067175", "pmid:37838461", "pmid:35552375", "pmid:41987169", "pmid:42442141" ], "studies": [ { "id": "pmid:42798126", "pmid": "42798126", "doi": "10.1097/MD.0000000000050716", "nctId": null, "pmcid": "PMC13619253", "title": "A case report on the management of sepsis complicated by eroded mixed hemorrhoids following breast cancer chemotherapy", "firstAuthor": "Ye", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "woman with breast cancer undergoing chemotherapy who developed severe infection after pushing prolapsed hemorrhoids back in", "intervention": "conservative treatment: antibiotics, blood/immune support, and multimodal wound care including traditional Chinese medicine", "comparator": "no comparator (single case)", "primaryOutcome": "resolution of fever, perianal infection, and hemorrhoid healing", "result": "after 30 days of treatment, fever resolved and the eroded hemorrhoid healed completely", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot reliably show whether manual reduction of hemorrhoids is safe or effective in general.", "directness": "indirect", "relevanceNote": "", "limitations": "single case report in a severely immunocompromised cancer patient; multiple simultaneous treatments make it impossible to know what helped; manual reduction itself led to an erosion and life-threatening infection in this case, not a planned safety study of the technique", "followUp": "30 days", "plainFinding": "Pushing it back in caused serious infection.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42798126/", "sourceText": "RATIONALE: Sepsis is a life-threatening complication in breast cancer patients undergoing chemotherapy, particularly when compounded by anorectal conditions. The management of eroded mixed hemorrhoids in the setting of severe chemotherapy-induced neutropenia and septicemia presents a clinical dilemma, as standard surgical interventions carry prohibitive risks. This case report details a successful conservative, multimodal approach to this rare and critical scenario. PATIENT CONCERNS: A 51-year-old female with stage IIIA human epidermal growth factor receptor 2-positive breast cancer developed a high fever (40.1°C) 1 week after her first cycle of neoadjuvant TCHP (docetaxel, carboplatin, trastuzumab, and pertuzumab) chemotherapy. She presented with severe bone marrow suppression and constipation, which led to the manual reduction of prolapsed hemorrhoids, resulting in an eroded, inflamed perianal mass. DIAGNOSES: The patient was diagnosed with septicemia (confirmed by Escherichia coli bacteremia), chemotherapy-induced grade IV bone marrow suppression (white blood cell count 0.17 × 109/L, platelet count 6 × 109/L), and mixed hemorrhoids with erosion and secondary perianal infection. INTERVENTIONS: Given the high risk of surgery due to critical thrombocytopenia and neutropenia, a conservative strategy was implemented. This included broad-spectrum systemic antibiotics (meropenem, vancomycin, amikacin, amphotericin B sequentially), aggressive hematologic support (granulocyte colony-stimulating factor, blood transfusions), and meticulous multimodal local wound care. The local regimen comprised saline cleansing, infrared therapy, recombinant human epidermal growth factor gel, zinc oxide ointment, compound borneol ester suppositories, and the topical application of a self-prepared traditional Chinese medicine, \"Liuhe Dan.\" OUTCOMES: After 30 days of treatment, the patient became afebrile, and her perianal swelling and inflammation completely resolved. The eroded hemorrhoid healed entirely, allowing for a successful transfer to a lower-level hospital for continued supportive care. LESSONS: This case demonstrates that in severely neutropenic and thrombocytopenic patients, a conservative, integrated approach combining systemic anti-infective therapy with advanced local wound care and traditional Chinese medicine can successfully manage life-threatening sepsis originating from eroded hemorrhoids. It underscores the critical importance of perianal hygiene, prompt management of chemotherapy-induced constipation and bone marrow suppression, and the potential of nonsurgical strategies in high-risk surgical candidates.", "provenance": [ { "field": "population", "quote": "A 51-year-old female with stage IIIA human epidermal growth factor receptor 2-positive breast cancer developed a high fever (40.1°C) 1 week after her first cycle of neoadjuvant TCHP" }, { "field": "intervention", "quote": "broad-spectrum systemic antibiotics (meropenem, vancomycin, amikacin, amphotericin B sequentially), aggressive hematologic support (granulocyte colony-stimulating factor, blood transfusions), and meticulous multimodal local wound care" }, { "field": "comparator", "quote": "This case report details a successful conservative, multimodal approach to this rare and critical scenario." }, { "field": "primaryOutcome", "quote": "After 30 days of treatment, the patient became afebrile, and her perianal swelling and inflammation completely resolved." }, { "field": "result", "quote": "The eroded hemorrhoid healed entirely, allowing for a successful transfer to a lower-level hospital for continued supportive care." }, { "field": "n", "quote": "A 51-year-old female with stage IIIA human epidermal growth factor receptor 2-positive breast cancer" } ] }, { "id": "pmid:42442141", "pmid": "42442141", "doi": "10.1016/j.surg.2026.110402", "nctId": null, "pmcid": null, "title": "Use of mesoglycan in the acute phase of hemorrhoidal disease, the aCute HaemORrhoidal MEsoglycan Study (CHORMES): A double-blind, randomized controlled trial", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Surgery", "year": 2026, "design": "rct", "n": 52, "nField": "reported", "population": "adults with symptomatic grade II to III hemorrhoid disease", "intervention": "oral mesoglycan taken daily for 40 days", "comparator": "placebo", "primaryOutcome": "change in hemorrhoid symptom score (pain, itching, bleeding, swelling/prolapse) from baseline to day 40", "result": "mesoglycan group had a significantly larger drop in symptom score than placebo, with reductions in itching, pain, and swelling/prolapse", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small phase 2 trial of only 52 patients, and it tests a drug for symptoms rather than directly testing a manual reduction technique for prolapse.", "directness": "indirect", "relevanceNote": "", "limitations": "small sample size; this is a phase 2 trial; it studies an oral drug treatment, not a physical/manual reduction technique for prolapse.", "followUp": "40 days treatment plus 30-day telephone follow-up", "plainFinding": "Drug reduced hemorrhoid prolapse symptoms, not manual reduction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42442141/", "sourceText": "BACKGROUND: Hemorrhoidal disease is a common condition with significant clinical and socioeconomic impact. Mesoglycan, with endothelial-protective, antithrombotic, and profibrinolytic properties, has shown potential benefits in postoperative hemorrhoidal disease management. The aCute HaemORrhoidal MEsoglycan Study trial was designed to evaluate the efficacy and safety of mesoglycan in the acute phase of hemorrhoidal disease. METHODS: This multicenter, randomized, double-blind, placebo-controlled phase 2 trial enrolled adults with symptomatic grade II to III hemorrhoidal disease. Participants were randomly assigned (1:1) to receive oral mesoglycan or placebo for 40 days, followed by a 30-day telephone follow-up. The primary endpoint was the change in the Hemorrhoidal Disease Symptom Score from baseline to day 40. Analyses were performed on modified intention-to-treat and modified per-protocol populations. RESULTS: Fifty-two patients were randomized (26 mesoglycan, 26 placebo), and 48 completed the study. In the modified intention-to-treat population (n = 47), mesoglycan resulted in a significantly greater reduction in Hemorrhoidal Disease Symptom Score compared with placebo (-7.5 ± 5.9 vs -3.9 ± 5.4; P = .027). Improvements were consistent across sensitivity analyses and more pronounced in patients with grade III hemorrhoidal disease (P = .042). Symptom-specific analysis showed significant reductions in itching (P = .0048), pain (P = .0246), and swelling/prolapse (P = .0418) in the mesoglycan group. Pain relief (visual analog scale) was sustained only in the mesoglycan arm. Bleeding improved significantly in the grade III subgroup (P = .03). Treatment adherence exceeded 97% in both arms. No treatment-related serious adverse events were observed. CONCLUSION: Mesoglycan demonstrated clinically meaningful and statistically significant improvements in acute hemorrhoidal disease symptoms, with a favorable safety profile and excellent adherence. Its mechanism of action allows for sustained benefits beyond mere symptomatic relief.", "provenance": [ { "field": "n", "quote": "Fifty-two patients were randomized (26 mesoglycan, 26 placebo), and 48 completed the study." }, { "field": "population", "quote": "enrolled adults with symptomatic grade II to III hemorrhoidal disease" }, { "field": "intervention", "quote": "Participants were randomly assigned (1:1) to receive oral mesoglycan or placebo for 40 days" }, { "field": "comparator", "quote": "receive oral mesoglycan or placebo for 40 days" }, { "field": "primaryOutcome", "quote": "The primary endpoint was the change in the Hemorrhoidal Disease Symptom Score from baseline to day 40." }, { "field": "result", "quote": "mesoglycan resulted in a significantly greater reduction in Hemorrhoidal Disease Symptom Score compared with placebo (-7.5 ± 5.9 vs -3.9 ± 5.4; P = .027)" }, { "field": "result", "quote": "Symptom-specific analysis showed significant reductions in itching (P = .0048), pain (P = .0246), and swelling/prolapse (P = .0418) in the mesoglycan group." } ] }, { "id": "pmid:42067175", "pmid": "42067175", "doi": "10.1016/j.cgh.2026.04.008", "nctId": null, "pmcid": null, "title": "AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review", "firstAuthor": "Qureshi", "multipleAuthors": true, "journal": "Clin Gastroenterol Hepatol", "year": 2026, "design": "guideline", "n": null, "nField": "not-reported", "population": "patients with hemorrhoids, including those with prolapse", "intervention": "treatments for hemorrhoids such as banding, infrared coagulation, topical agents and surgery", "comparator": "surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids", "primaryOutcome": "long-term treatment success for prolapsing hemorrhoids and recurrent bleeding", "result": "Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding, but the abstract does not describe manual reduction of a prolapsed hemorrhoid.", "resultDirection": "unclear", "quality": "low", "qualityWhy": "These are expert opinion best-practice statements without a systematic review or formal quality rating, so they carry limited evidentiary weight.", "directness": "indirect", "relevanceNote": "", "limitations": "Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.", "followUp": "", "plainFinding": "Doesn't address pushing it back in.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42067175/", "sourceText": "DESCRIPTION: Hemorrhoids are a common problem. The diagnosis and treatment can be challenging. Gastroenterologists have much to offer these patients. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review is to provide best practice advice (BPA) covering the diagnosis and treatment of hemorrhoid disease. METHODS: This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These BPA statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BPA 1: The diagnosis and treatment of hemorrhoids is within the purview of the gastroenterologist. The diagnosis and grading of hemorrhoids is easily made by taking a history from the patient and examining the patient. Symptoms caused by hemorrhoids include bleeding, itching, discomfort, and/or prolapse. Hemorrhoids only cause significant pain when acutely thrombosed. Sharp pain on defecation is most likely anal fissure. BPA 2: Dietary and lifestyle modifications, including increasing fiber intake and avoiding straining or prolonged time on the toilet, are reasonable first-line therapies for symptomatic hemorrhoids. The use of sitz baths for symptom improvement in symptomatic hemorrhoids is often advised, but scientific data is limited. BPA 3: Topical treatments, including anesthetics, astringents (witch hazel), corticosteroids, and vasoactive agents, can be considered for treatment of symptomatic hemorrhoids, but there is little data to support efficacy. Topical steroids should not be used for more than 2 weeks at a time. BPA 4: Anoscopy should be performed, whenever possible, on every new patient with suspected hemorrhoids, prior to treatment, to ensure accurate diagnosis. BPA 5: Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting. Infrared coagulation and rubber band ligation have similar benefits in the short term. Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding. Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids. BPA 6: As part of informed consent for hemorrhoid therapies, the patient must be made aware of the small possibility of pelvic sepsis as a complication. Patients should be counseled about the risk and instructed to present to the emergency department immediately for evaluation, if indicated. BPA 7: In patients with active Crohn's disease or ulcerative colitis, hemorrhoid disease management should be delayed until complete remission is achieved. BPA 8: Hemorrhoids occur in up to two-thirds of women during pregnancy. Treatment should generally involve conservative management, including fiber, treatment of constipation, and topical ointments. If symptoms persist postpartum, or if a woman is planning further pregnancies, standard treatment such as banding or infrared coagulation can be considered. BPA 9: Acute thrombosed hemorrhoids are often extremely painful. They are best treated surgically with incision and drainage. BPA 10: Consultation with a surgeon should be offered to patients with grade 3 internal hemorrhoids who fail banding procedures or have associated external hemorrhoids. Large skin tags can be removed without a hemorrhoidectomy if they are not associated with significant hemorrhoids. Grade 4 internal hemorrhoids require surgical hemorrhoidectomy. BPA 11: Patients with cirrhosis and hemorrhoids should be carefully examined so as not to confuse hemorrhoids with rectal varices. Hemorrhoids in patients with cirrhosis can be treated with banding or infrared coagulation. In patients with significant coagulopathy, infrared coagulation is preferred to banding. Concomitant portal hypertension should not alter this approach. For most clinicians, significant coagulopathy means a platelet count of less than 50,000 per microliter or international normalized ratio greater than 2.0. The presence of concomitant portal hypertension should not alter this approach.", "provenance": [ { "field": "population", "quote": "Hemorrhoids are a common problem." }, { "field": "intervention", "quote": "Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting." }, { "field": "comparator", "quote": "Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids." }, { "field": "primaryOutcome", "quote": "Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding." }, { "field": "result", "quote": "Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding." }, { "field": "limitations", "quote": "Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations." } ] }, { "id": "pmid:41987169", "pmid": "41987169", "doi": "10.1186/s12893-026-03744-z", "nctId": null, "pmcid": "PMC13220367", "title": "Evaluation of short-term outcomes of Endoscopic Super-Hemorrhoidal Banding for mixed hemorrhoids with prolapsed internal hemorrhoids: a retrospective study", "firstAuthor": "Huang", "multipleAuthors": true, "journal": "BMC Surg", "year": 2026, "design": "retrospective", "n": 480, "nField": "reported", "population": "adults with mixed hemorrhoids and grade II-IV internal hemorrhoid prolapse", "intervention": "endoscopic band repositioning of the prolapsed hemorrhoid tissue (ESHB)", "comparator": "standard surgical hemorrhoid removal (Milligan-Morgan hemorrhoidectomy)", "primaryOutcome": "cure rate, operative time, hospital stay, pain scores, and complications", "result": "similar cure rates between the two treatments, but the banding procedure had shorter surgery and hospital stay, less pain, and fewer urinary retention complications", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a retrospective (non-randomized) comparison with only short-term follow-up, so it can't rule out bias and doesn't show long-term results", "directness": "indirect", "relevanceNote": "", "limitations": "retrospective design, short-term follow-up only, long-term efficacy not yet validated", "followUp": "", "plainFinding": "Similar cure, less pain and recovery time", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41987169/", "sourceText": "BACKGROUND: To evaluate the clinical efficacy and safety of Endoscopic Super-hemorrhoidal Banding (ESHB) in treating mixed hemorrhoids with Grade II-IV internal hemorrhoid prolapse as the main symptom. METHODS: A retrospective analysis was conducted on clinical data of patients with mixed hemorrhoids treated in our hospital from June 2021 to June 2024. They were divided into two groups: patients underwent Milligan-Morgan hemorrhoidectomy (MMH) as the control group, and patients underwent ESHB as the observation group. Treatment outcomes included efficacy measurement, operative time, hospital stay, postoperative anal pain scores, and incidence of complications like bleeding and urinary retention were compared. RESULTS: 245 patients underwent Milligan-Morgan hemorrhoidectomy (MMH) and 235 patients underwent ESHB. The cure rates were 69.36% in the ESHB group and 72.65% in the MMH group, with no statistically significant difference between the two groups (P > 0.05). The observation group had significantly shorter operative time and hospital stay (P < 0.01), lower postoperative anal pain scores and incidence of urinary retention (P < 0.01). One patient in each group had severe postoperative bleeding, which stopped after surgical suture or endoscopic titanium clip closure. CONCLUSION: Short-term follow-up indicates that ESHB can effectively reposition the prolapsed anal cushions, preserve the anatomical structure and functional integrity of the anal cushions, alleviate symptoms associated with mixed hemorrhoids primarily characterized by internal hemorrhoid prolapse, shorten both the operative time and hospital stay, and reduce patients’ postoperative anal pain scores as well as the incidence of postoperative complications. It is an effective, safe, and simple minimally invasive treatment method; however, its long-term efficacy still requires further validation. TRIAL REGISTRATION: This was a retrospective observational study. Trial registration was performed retrospectively (registration no.: NCT06250140; registration date: January 31, 2024).", "provenance": [ { "field": "population", "quote": "patients with mixed hemorrhoids treated in our hospital from June 2021 to June 2024" }, { "field": "intervention", "quote": "Endoscopic Super-hemorrhoidal Banding (ESHB)" }, { "field": "comparator", "quote": "Milligan-Morgan hemorrhoidectomy (MMH)" }, { "field": "primaryOutcome", "quote": "Treatment outcomes included efficacy measurement, operative time, hospital stay, postoperative anal pain scores, and incidence of complications like bleeding and urinary retention were compared." }, { "field": "result", "quote": "The cure rates were 69.36% in the ESHB group and 72.65% in the MMH group, with no statistically significant difference between the two groups (P > 0.05). The observation group had significantly shorter operative time and hospital stay (P < 0.01), lower postoperative anal pain scores and incidence of urinary retention (P < 0.01)." }, { "field": "n", "quote": "245 patients underwent Milligan-Morgan hemorrhoidectomy (MMH) and 235 patients underwent ESHB." } ] }, { "id": "pmid:41693967", "pmid": "41693967", "doi": "10.3748/wjg.v32.i5.116007", "nctId": null, "pmcid": "PMC12897523", "title": "Endoscopic rubber band ligation, injection sclerotherapy, and sclerobanding for the treatment of internal hemorrhoids", "firstAuthor": "Zu", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2026, "design": "retrospective", "n": 201, "nField": "reported", "population": "patients with grade I-III internal hemorrhoids treated endoscopically", "intervention": "endoscopic treatments for internal hemorrhoids: rubber band ligation, injection sclerotherapy, or combined sclerobanding", "comparator": "the three endoscopic treatment methods compared against each other", "primaryOutcome": "clinical efficacy, recurrence rates, and postoperative adverse events", "result": "combined sclerobanding had lower recurrence and less pain than sclerotherapy or banding alone for grade II-III hemorrhoids, with no difference for grade I", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective study comparing treatment groups rather than a randomized trial, so differences could be due to other factors.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective cohort design; comparison is between different endoscopic treatments, not about manual reduction of a prolapsed hemorrhoid.", "followUp": "24 months", "plainFinding": "Combined scar-and-band treatment reduced recurrence and pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41693967/", "sourceText": "BACKGROUND: The clinical outcomes of endoscopic rubber band ligation (ERBL), injection sclerotherapy (IS), and endoscopic polidocanol sclerobanding (ESB) have not yet been well studied. AIM: To evaluate the efficacy and safety of ERBL, IS, and ESB for treating grade I-III internal hemorrhoids. METHODS: This retrospective cohort study was performed on 201 patients, who were grouped according to their endoscopic treatment (ERBL, IS, and ESB groups). Postoperative follow-ups were initially carried out at 1, 3, and 6 months, and then every 6 months, with the longest follow-up extending to 24 months. The study analyzed clinical efficacy, short-term and overall recurrence rates, and postoperative adverse events. Additionally, subgroup analysis was conducted based on the internal hemorrhoid grade (I or II-III). RESULTS: The patient distribution across the ERBL, IS, and ESB groups was 70, 66, and 65, respectively. Both the ERBL and ESB groups demonstrated lower overall recurrence rates compared with the IS group (post-hoc analysis, P' = 0.024 and P' = 0.015, respectively). Subgroup analysis revealed that sclerotherapy resulted in a higher total recurrence rate than that achieved by sclerobanding (45.95% vs 19.57%, P' = 0.03), specifically for grade II-III internal hemorrhoids. No significant difference was found in grade I hemorrhoids. The ERBL group exhibited a higher incidence of postoperative pain, a worse median visual analog scale score, and a longer median duration of pain compared with those reported by the other groups (P < 0.001). This trend was consistent for grade II-III hemorrhoids. No significant differences were found among the three groups regarding clinical efficacy or recurrence rates within 6 months post-surgery, even when examined by subgroup. CONCLUSION: The three treatments evaluated (ERBL, IS, and ESB) provide durable clinical outcomes for grade I hemorrhoids, with no significant differences in postoperative adverse events. For grade II-III hemorrhoids, ESB possesses the dual advantages of lower recurrence rates and reduced postoperative pain compared with IS and ERBL.", "provenance": [ { "field": "n", "quote": "This retrospective cohort study was performed on 201 patients" }, { "field": "population", "quote": "treating grade I-III internal hemorrhoids" }, { "field": "intervention", "quote": "endoscopic rubber band ligation (ERBL), injection sclerotherapy (IS), and endoscopic polidocanol sclerobanding (ESB)" }, { "field": "comparator", "quote": "grouped according to their endoscopic treatment (ERBL, IS, and ESB groups)" }, { "field": "primaryOutcome", "quote": "The study analyzed clinical efficacy, short-term and overall recurrence rates, and postoperative adverse events." }, { "field": "result", "quote": "For grade II-III hemorrhoids, ESB possesses the dual advantages of lower recurrence rates and reduced postoperative pain compared with IS and ERBL." }, { "field": "result", "quote": "No significant difference was found in grade I hemorrhoids." }, { "field": "followUp", "quote": "with the longest follow-up extending to 24 months" } ] }, { "id": "pmid:41480327", "pmid": "41480327", "doi": "10.3748/wjg.v31.i48.114738", "nctId": null, "pmcid": "PMC12754228", "title": "Transverse incision with longitudinal ligation procedure: Innovation, pitfalls, and clinical perspectives", "firstAuthor": "Hua", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with prolapsed hemorrhoids that go all the way around the anus", "intervention": "a new surgical technique called transverse incision with longitudinal ligation (TILL)", "comparator": "traditional Milligan-Morgan hemorrhoidectomy surgery", "primaryOutcome": "short-term results including pain, healing speed, and anal narrowing", "result": "TILL showed less pain, quicker healing, and lower risk of anal stenosis than Milligan-Morgan surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a commentary letter about a single small retrospective study with short follow-up, not new direct evidence.", "directness": "indirect", "relevanceNote": "", "limitations": "The abstract itself states the original study was retrospective, single-center, had a small sample size, and short follow-up, limiting generalizability and assessment of long-term outcomes like recurrence.", "followUp": "", "plainFinding": "New surgery had fewer short-term complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41480327/", "sourceText": "The transverse incision with longitudinal ligation (TILL) procedure is a new method for treating circumferential prolapsed hemorrhoids. A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results, showing less pain, quicker healing, and lower risk of anal stenosis. TILL reduces tissue tension and controls blood supply, allowing effective removal of diseased tissue while maintaining anal function and structure. However, the study's limitations, including its retrospective, single-center design, small sample size, and short follow-up, restrict the findings' generalizability and ability to assess long-term outcomes like recurrence. Larger, multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.", "provenance": [ { "field": "population", "quote": "circumferential prolapsed hemorrhoids" }, { "field": "intervention", "quote": "transverse incision with longitudinal ligation (TILL) procedure is a new method for treating circumferential prolapsed hemorrhoids" }, { "field": "comparator", "quote": "traditional Milligan-Morgan hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results, showing less pain, quicker healing, and lower risk of anal stenosis" }, { "field": "result", "quote": "TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results, showing less pain, quicker healing, and lower risk of anal stenosis" }, { "field": "limitations", "quote": "the study's limitations, including its retrospective, single-center design, small sample size, and short follow-up, restrict the findings' generalizability and ability to assess long-term outcomes like recurrence" } ] }, { "id": "pmid:40922264", "pmid": "40922264", "doi": "10.1097/MD.0000000000044368", "nctId": null, "pmcid": "PMC12419330", "title": "Combined therapy of HIFU rectoanal lifting (HIFU-RAL) and sclerotherapy for prolapsed hemorrhoids and rectal mucosal prolapse: A case series", "firstAuthor": "Suzuki", "multipleAuthors": false, "journal": "Medicine (Baltimore)", "year": 2025, "design": "case-series", "n": 10, "nField": "reported", "population": "patients with prolapsed hemorrhoids or rectal mucosal prolapse causing discomfort", "intervention": "combined HIFU rectoanal lifting (HIFU-RAL) and ALTA sclerotherapy injection", "comparator": "none (single-arm case series, compared to before treatment)", "primaryOutcome": "visible reduction or resolution of prolapsed lesions and recurrence over follow-up", "result": "all cases showed visible reduction or resolution of prolapse immediately after procedure, with no adverse events or recurrences during follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a tiny uncontrolled case series of only 10 patients with no comparison group, so it cannot reliably show the treatment works better than other options.", "directness": "indirect", "relevanceNote": "", "limitations": "Very small sample size, no control or comparator group, single case series design.", "followUp": "median: 16.0 months; interquartile range: 10.5-25.8 months", "plainFinding": "Prolapse reduced, no recurrence seen.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40922264/", "sourceText": "RATIONALE: Prolapsed hemorrhoids can impair quality of life due to associated symptoms such as pain. While hemorrhoidectomy is considered the gold standard for treating prolapsed hemorrhoids, this procedure inevitably involves complications such as postoperative pain, bleeding, and delayed recovery. Therefore, there is an increasing need for treatment options that are immediate, effective, and minimally invasive, while also taking into account patients' physical and social backgrounds, preferences, and values. In this study, we applied a transanal high-intensity focused ultrasound (HIFU) technique, namely HIFU rectal lifting (HIFU-RAL), combined with aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for treating prolapsed hemorrhoids and assessed its efficacy. PATIENT CONCERNS: This case series included 10 symptomatic patients, consisting of 5 men and 5 women. The mean patient age was 67.2 ± 11.0 years, and the median disease duration was 8.0 years (interquartile range: 3.5-38.8 years). All patients complained of prolapse and discomfort that impaired their daily lives. DIAGNOSES: Clinical examination identified 8 cases of prolapsed hemorrhoids (Goligher grade III-IV) and 2 cases of rectal mucosal prolapse. INTERVENTIONS: HIFU-RAL is a transanal HIFU technique originally developed to treat fecal and urinary incontinence. In this procedure, circumferential ultrasound energy was delivered to the longitudinal muscle of the rectum through the mucosal surface, oral to the dentate line. In ALTA sclerotherapy, the sclerosant was injected into the internal hemorrhoids for prolapsed hemorrhoids and into the submucosal layer of the rectum for rectal mucosal prolapse. The combined efficacy of HIFU-RAL and ALTA sclerotherapy was evaluated over time. OUTCOMES: The combined HIFU-RAL procedure and ALTA sclerotherapy were completed in 19.2 ± 6.6 minutes. In all cases, the prolapsed lesions were visibly reduced or resolved immediately after the procedure. During the follow-up period (median: 16.0 months; interquartile range: 10.5-25.8 months), no adverse events or recurrences were observed. LESSONS: The HIFU-RAL procedure combined with ALTA sclerotherapy is a promising, minimally invasive, office-based treatment for prolapsed hemorrhoids. The HIFU-RAL procedure induces contraction of the heated rectal longitudinal muscle, repositioning hemorrhoids to their anatomical site and visibly reducing or eliminating the area of prolapsed lesions.", "provenance": [ { "field": "n", "quote": "This case series included 10 symptomatic patients, consisting of 5 men and 5 women." }, { "field": "population", "quote": "Clinical examination identified 8 cases of prolapsed hemorrhoids (Goligher grade III-IV) and 2 cases of rectal mucosal prolapse." }, { "field": "intervention", "quote": "we applied a transanal high-intensity focused ultrasound (HIFU) technique, namely HIFU rectal lifting (HIFU-RAL), combined with aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for treating prolapsed hemorrhoids" }, { "field": "comparator", "quote": "The combined efficacy of HIFU-RAL and ALTA sclerotherapy was evaluated over time." }, { "field": "primaryOutcome", "quote": "In all cases, the prolapsed lesions were visibly reduced or resolved immediately after the procedure." }, { "field": "result", "quote": "During the follow-up period (median: 16.0 months; interquartile range: 10.5-25.8 months), no adverse events or recurrences were observed." } ] }, { "id": "pmid:40586790", "pmid": "40586790", "doi": "10.1007/s00104-025-02335-7", "nctId": null, "pmcid": null, "title": "[Hemorrhoidal disease and stage-dependent treatment (including anal prolapse)]", "firstAuthor": "Schwandner", "multipleAuthors": false, "journal": "Chirurgie (Heidelb)", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoidal disease at various stages", "intervention": "stage-based treatment of hemorrhoids (conservative, interventional, or surgical)", "comparator": "different treatment stages/options compared to each other", "primaryOutcome": "symptom control and long-term prevention of recurrence", "result": "treatment choice depends on disease stage; acute anal prolapse is managed conservatively and topically", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a general review describing treatment approaches rather than presenting original trial data on outcomes.", "directness": "indirect", "relevanceNote": "", "limitations": "abstract does not report specific study data, patient numbers, or comparative outcome results for reducing prolapse.", "followUp": "", "plainFinding": "Acute prolapse treated conservatively, not surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40586790/", "sourceText": "The treatment of hemorrhoidal disease is carried out depending on the symptoms and stage of the disease. Although conservative and interventional treatment options (including sclerotherapy, rubber band ligation) are indicated in early stages (stages I and II), surgical procedures are effective treatment options for advanced hemorrhoidal disease (stages III and IV). In this context, \"conventional\" hemorrhoidectomy procedures are increasingly in competition with minimally invasive techniques (e.g. hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation). In cases of acute anal prolapse, a conservative and topical approach is indicated. The ultimate goal of all treatment strategies for hemorrhoidal disease is symptom control and long-term absence of recurrence.", "provenance": [ { "field": "population", "quote": "The treatment of hemorrhoidal disease is carried out depending on the symptoms and stage of the disease." }, { "field": "intervention", "quote": "The treatment of hemorrhoidal disease is carried out depending on the symptoms and stage of the disease." }, { "field": "comparator", "quote": "\"conventional\" hemorrhoidectomy procedures are increasingly in competition with minimally invasive techniques (e.g. hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation)" }, { "field": "primaryOutcome", "quote": "The ultimate goal of all treatment strategies for hemorrhoidal disease is symptom control and long-term absence of recurrence." }, { "field": "result", "quote": "In cases of acute anal prolapse, a conservative and topical approach is indicated." } ] }, { "id": "pmid:40581544", "pmid": "40581544", "doi": "10.1016/j.surge.2025.06.002", "nctId": null, "pmcid": null, "title": "Comparative efficacy of lidocaine- and nifedipine-based conservative therapies in acute hemorrhoidal disease: A retrospective cohort study", "firstAuthor": "Schiano di Visconte", "multipleAuthors": false, "journal": "Surgeon", "year": 2025, "design": "retrospective", "n": 123, "nField": "reported", "population": "adults with acute hemorrhoidal disease treated at a hospital", "intervention": "oral diosmin/hesperidin plus bromelain plus topical lidocaine cream", "comparator": "oral diosmin/hesperidin plus bromelain plus topical nifedipine cream", "primaryOutcome": "symptom scores for pain and hemorrhoid severity over 21 days", "result": "the lidocaine-based treatment reduced pain and symptom scores faster than the nifedipine-based treatment, especially by day 7", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective chart review without randomization or blinding, so differences between groups could be due to other factors.", "directness": "indirect", "relevanceNote": "", "limitations": "retrospective design, single center, no mention of randomization or blinding, short follow-up", "followUp": "21 days", "plainFinding": "Lidocaine cream eased pain faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40581544/", "sourceText": "BACKGROUND: Acute hemorrhoidal disease (AHD) is a prevalent anorectal condition that significantly impacts patients' quality of life and healthcare systems. Despite the availability of various conservative treatments, comparative efficacy data remains limited. This retrospective study evaluates two treatment regimens for AHD, focusing on symptom relief, patient-reported outcomes, and treatment tolerability. METHODS: Medical records of 123 patients with AHD treated at a tertiary care center between October 2022 and October 2024 were reviewed. Patients were divided into two groups: Group A treated with oral diosmin/hesperidin, bromelain, and topical lidocaine, and Group B treated with oral diosmin/hesperidin, bromelain, and topical nifedipine. Symptoms were evaluated using the Hemorrhoidal Disease Symptom Score (HDSS), Visual Analog Scale (VAS) for pain, and Short Health Scale for Hemorrhoidal Disease (SHS-HD) at baseline and on days 7, 14, and 21. RESULTS: Both groups showed significant improvements in symptoms during the study period. Group A demonstrated faster pain reduction (VAS day 7:0.17 ± 0.52 vs. 2.20 ± 1.11, p < 0.001) and greater improvement in HDSS score (day 7: 0.02 ± 0.87 vs. 10.16 ± 3.38, p < 0.001). Improvements in SHS-HD scores were more rapid for Group A, with scores on day 7 showing a significant difference (Group A: 7.58 ± 2.58 vs. Group B: 12.27 ± 4.21, p < 0.001). Both regimens were well tolerated, with no significant adverse events. CONCLUSIONS: The combination of oral diosmin/hesperidin, bromelain, and lidocaine provides superior initial symptom relief compared with nifedipine-based regimens. Lidocaine is the preferred topical agent for rapid pain management in AHD patients. Further studies are required to confirm these results.", "provenance": [ { "field": "design", "quote": "This retrospective study evaluates two treatment regimens for AHD" }, { "field": "n", "quote": "Medical records of 123 patients with AHD treated at a tertiary care center between October 2022 and October 2024 were reviewed." }, { "field": "population", "quote": "patients with AHD treated at a tertiary care center" }, { "field": "intervention", "quote": "Group A treated with oral diosmin/hesperidin, bromelain, and topical lidocaine" }, { "field": "comparator", "quote": "Group B treated with oral diosmin/hesperidin, bromelain, and topical nifedipine" }, { "field": "primaryOutcome", "quote": "Symptoms were evaluated using the Hemorrhoidal Disease Symptom Score (HDSS), Visual Analog Scale (VAS) for pain, and Short Health Scale for Hemorrhoidal Disease (SHS-HD) at baseline and on days 7, 14, and 21." }, { "field": "result", "quote": "Group A demonstrated faster pain reduction (VAS day 7:0.17 ± 0.52 vs. 2.20 ± 1.11, p < 0.001) and greater improvement in HDSS score (day 7: 0.02 ± 0.87 vs. 10.16 ± 3.38, p < 0.001)." }, { "field": "followUp", "quote": "baseline and on days 7, 14, and 21" } ] }, { "id": "pmid:39957120", "pmid": "39957120", "doi": "10.62713/aic.3746", "nctId": null, "pmcid": null, "title": "Clinical Efficacy of Automatic Ruiyun Procedure for Hemorrhoids and Procedure for Prolapse and Hemorrhoids in the Treatment of Mixed Hemorrhoids: A Comparative Study", "firstAuthor": "Xu", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2025, "design": "retrospective", "n": 120, "nField": "reported", "population": "patients with mixed hemorrhoids", "intervention": "Ruiyun procedure for hemorrhoids (RPH), a type of hemorrhoid surgery", "comparator": "procedure for prolapse and hemorrhoids (PPH), another type of hemorrhoid surgery", "primaryOutcome": "surgical time, pain, blood loss, hospital stay, cost, quality of life, complications, and readmission after surgery", "result": "RPH had shorter surgery time, less blood loss, less pain, shorter hospital stay, lower cost, and better quality of life scores than PPH; no significant difference in fecal incontinence scores or readmission rates", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective study from one hospital comparing two surgical techniques, which does not address manual reduction of a prolapsed hemorrhoid at all.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, single center, and the study compares two surgical procedures rather than non-surgical manual reduction techniques.", "followUp": "12th week", "plainFinding": "Not about manual reduction; compares two surgeries.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39957120/", "sourceText": "AIM: The occurrence of mixed hemorrhoids becomes increasingly more frequent with age, posing psychological pressure and distress to affected patients. This retrospective study aims to compare the clinical efficacy of automatic Ruiyun procedure for hemorrhoids and procedure for prolapse and hemorrhoids in the treatment of mixed hemorrhoids. METHODS: A retrospective cohort study of patients with mixed hemorrhoids who visited the Third Affiliated Hospital of Gansu University of Chinese Medicine (The 1st People's Hospital of Baiyin) from January 2019 to December 2023 was conducted using propensity score matching (PSM) with a ratio of 1:1 for nearest neighbor matching grouping. In this study, 60 cases were grouped under the Ruiyun procedure for hemorrhoids (RPH) group, and the other 60 cases were categorized in the procedure for prolapse and hemorrhoids (PPH) group. The postoperative medical humanistic evaluation, clinical efficacy evaluation, subjective evaluation of patients, the occurrence of complications and the rate of unplanned readmission were compared between the two groups. RESULTS: Surgical time, intraoperative blood loss, duration of postoperative pain, length of hospital stay and hospitalization expenses between the two groups presented statistically significant differences (p < 0.001). There were statistically significant intra-group and between-group differences between RPH group and PPH group in the visual analogue scale (VAS) scores on the 4th and 6th postoperative days (p < 0.001). The European Quality of Life-5 Dimensions, 5-Level Version (EQ-5D-5L) score in the RPH group was lower than that in the PPH group at the 12th week of follow-up (p < 0.001), signifying an improved level of quality of life. There was no difference in Vaizey's Fecal Incontinence Rating Scale score between the RPH group and the PPH group at the 12th week of follow-up (p > 0.05). The rate of unplanned postoperative readmission was higher in the PPH group than in the RPH group, although the difference was not of statistical significance (p > 0.05). CONCLUSIONS: RPH outperforms PPH in the treatment of mixed hemorrhoids with a shortened surgical time.", "provenance": [ { "field": "population", "quote": "patients with mixed hemorrhoids who visited the Third Affiliated Hospital of Gansu University of Chinese Medicine" }, { "field": "intervention", "quote": "automatic Ruiyun procedure for hemorrhoids" }, { "field": "comparator", "quote": "procedure for prolapse and hemorrhoids" }, { "field": "n", "quote": "60 cases were grouped under the Ruiyun procedure for hemorrhoids (RPH) group, and the other 60 cases were categorized in the procedure for prolapse and hemorrhoids (PPH) group" }, { "field": "primaryOutcome", "quote": "Surgical time, intraoperative blood loss, duration of postoperative pain, length of hospital stay and hospitalization expenses between the two groups presented statistically significant differences" }, { "field": "result", "quote": "RPH outperforms PPH in the treatment of mixed hemorrhoids with a shortened surgical time" }, { "field": "result", "quote": "There was no difference in Vaizey's Fecal Incontinence Rating Scale score between the RPH group and the PPH group at the 12th week of follow-up (p > 0.05)" }, { "field": "followUp", "quote": "at the 12th week of follow-up" } ] }, { "id": "pmid:39923169", "pmid": "39923169", "doi": "10.33314/jnhrc.v22i03.5135", "nctId": null, "pmcid": null, "title": "Efficacy and Safety of Colonoscopic Band Ligation for Lower Gastrointestinal Bleeding due to Hemorrhoid", "firstAuthor": "Sapkota Upadhya", "multipleAuthors": true, "journal": "J Nepal Health Res Counc", "year": 2024, "design": "case-series", "n": 28, "nField": "reported", "population": "patients with lower gastrointestinal bleeding caused by hemorrhoids (grade II)", "intervention": "colonoscopic rubber band ligation of hemorrhoids", "comparator": "none (no comparison group)", "primaryOutcome": "resolution of bleeding, prolapse, irritation, discharge and pain, and patient satisfaction", "result": "symptoms of irritation, discharge and pain resolved in all patients by 3 months, bleeding resolved in 96.4% and prolapse in 92%, with complications in 53.5% of cases", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small single-group case series with no comparison group and only short follow-up, so it can't reliably show how well the treatment works compared to other options.", "directness": "indirect", "relevanceNote": "", "limitations": "Single-center study, no control group, over half of patients had post-procedure complications, and only short-term follow-up was reported.", "followUp": "3 months", "plainFinding": "Band ligation relieved hemorrhoid bleeding and prolapse.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39923169/", "sourceText": "BACKGROUND: Lower gastrointestinal bleeding is a significant cause of morbidity and mortality. Hemorrhoids are frequently encountered cause of lower gastrointestinal bleeding in outpatient settings in Nepal. Rubber band ligation is one of the most important, cost-effective, and commonly used treatments for first to third-degree internal hemorrhoids. Colonoscopic Rubber band ligation provides enhanced visualization and maneuverability, improving safety and efficacy of Rubber band ligation compared to traditional Rubber band ligation methods. This study aimed to assess the safety, efficacy, and patient acceptance of Colonoscopic Rubber band ligation for lower Lower gastrointestinal bleeding due to hemorrhoids. METHODS: This study, conducted in a tertiary care center of Nepal over one year, explores the immediate, late complications, efficacy and treatment satisfaction of patients undergoing Colonoscopic Rubber band ligation for lower GI bleeding due to hemorrhoids. RESULTS: We included 28 among 108 patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding. Symptoms of irritation, discharge, pain resolved in all patients at 3 months and that of bleeding and prolapse in 96.4% and 92% respectively. 75% were able to resume work the day after the procedure. Post-procedure complications were reported in 53.5% of cases. 78.6% of patients rated Colonoscopic Rubber band ligation treatment as \"excellent help\". CONCLUSIONS: Colonoscopic Rubber band ligation is feasible, safe and efficient for the treatment of symptomatic grade II hemorrhoids with most patients experiencing relief and high satisfaction. Further multicenter research with longer follow-up is needed to confirm long-term effectiveness.", "provenance": [ { "field": "n", "quote": "We included 28 among 108 patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding." }, { "field": "population", "quote": "treatment of symptomatic grade II hemorrhoids" }, { "field": "intervention", "quote": "Colonoscopic Rubber band ligation" }, { "field": "comparator", "quote": "Colonoscopic Rubber band ligation provides enhanced visualization and maneuverability, improving safety and efficacy of Rubber band ligation compared to traditional Rubber band ligation methods." }, { "field": "primaryOutcome", "quote": "Symptoms of irritation, discharge, pain resolved in all patients at 3 months and that of bleeding and prolapse in 96.4% and 92% respectively." }, { "field": "result", "quote": "Post-procedure complications were reported in 53.5% of cases. 78.6% of patients rated Colonoscopic Rubber band ligation treatment as \"excellent help\"." } ] }, { "id": "pmid:39563748", "pmid": "39563748", "doi": "10.3748/wjg.v30.i42.4583", "nctId": null, "pmcid": "PMC11572621", "title": "Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids: A novel outpatient procedure", "firstAuthor": "Mou", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with grades II and III internal hemorrhoids", "intervention": "endoscopic polidocanol foam sclerobanding (EFSB)", "comparator": "endoscopic rubber band ligation (ERBL)", "primaryOutcome": "prolapse recurrence and post-procedural pain", "result": "EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a commentary discussing another study rather than original research, so it offers no independent data to judge safety or efficacy.", "directness": "indirect", "relevanceNote": "", "limitations": "The abstract itself states that larger samples, multiple treatment sessions, and longer follow-up are needed to confirm findings.", "followUp": "", "plainFinding": "New hemorrhoid procedure, benefit still unconfirmed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39563748/", "sourceText": "In the study, we comment on the article by Qu et al. Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding, prolapse, and difficulty in defecation. Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure. The main goal of ERBL is to alleviate prolapse, but the high incidence of recurrence and post-procedural pain are of clinical concern. Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding. Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h post-procedural pain. The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up. Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings.", "provenance": [ { "field": "population", "quote": "patients with grades II and III internal hemorrhoids with one-year follow-up" }, { "field": "intervention", "quote": "Endoscopic polidocanol foam sclerobanding (EFSB)" }, { "field": "comparator", "quote": "Endoscopic rubber band ligation (ERBL)" }, { "field": "primaryOutcome", "quote": "long-term relief from prolapse recurrence and reduced 24-h post-procedural pain" }, { "field": "result", "quote": "Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings." } ] }, { "id": "pmid:38677814", "pmid": "38677814", "doi": "10.1016/j.suc.2023.11.001", "nctId": null, "pmcid": null, "title": "Management of Hemorrhoids and Anal Fissures", "firstAuthor": "Akinmoladun", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids or anal fissures", "intervention": "medical and surgical treatment options for hemorrhoids and anal fissures", "comparator": "", "primaryOutcome": "", "result": "The abstract does not report specific results on manually reducing a prolapsed hemorrhoid; it is a general overview of diagnosis and treatment options.", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review that does not report specific data, methods, or results on manual reduction of prolapsed hemorrhoids.", "directness": "indirect", "relevanceNote": "", "limitations": "The abstract gives no specific information about manual reduction technique, safety, or outcomes; it is a broad overview of hemorrhoid and fissure management.", "followUp": "", "plainFinding": "No specific answer given", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38677814/", "sourceText": "Hemorrhoids and anal fissures are two of the most common benign anorectal diseases. Despite their high prevalence, diagnostic accuracy of benign anorectal disease is suboptimal at 70% for surgeons, especially for hemorrhoidal diseases. Once the diagnosis is correctly made, numerous medical and surgical treatment options are available, each with different rates of success and complications. In this article, the authors review each step of patient management, with emphasis on evidence-based treatment options for hemorrhoids and anal fissures. The article discusses the pathophysiology, diagnosis, medical management, and procedures for hemorrhoids followed by a detailed overview on the management of anal fissures.", "provenance": [ { "field": "population", "quote": "Hemorrhoids and anal fissures are two of the most common benign anorectal diseases." }, { "field": "intervention", "quote": "numerous medical and surgical treatment options are available, each with different rates of success and complications" }, { "field": "result", "quote": "The article discusses the pathophysiology, diagnosis, medical management, and procedures for hemorrhoids followed by a detailed overview on the management of anal fissures." } ] }, { "id": "pmid:38580520", "pmid": "38580520", "doi": "10.1016/j.jviscsurg.2024.03.005", "nctId": null, "pmcid": null, "title": "Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management", "firstAuthor": "Fathallah", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2024, "design": "prospective-cohort", "n": 472, "nField": "reported", "population": "patients with hemorrhoidal disease seeking care", "intervention": "medical, instrumental, or surgical treatment for hemorrhoids", "comparator": "different treatment modalities compared with each other (medical vs instrumental vs surgical)", "primaryOutcome": "change in bleeding and prolapse scores and patient satisfaction after treatment", "result": "bleeding and prolapse scores improved significantly after treatment, with greater improvement and higher satisfaction in the surgery group (73% vs 54% very good satisfaction)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single-center observational study without randomization, so differences between treatment groups could be due to patient selection rather than treatment itself.", "directness": "indirect", "relevanceNote": "", "limitations": "Single-center, non-randomized, patients not randomly assigned to treatment groups, so comparisons between medical, instrumental, and surgical treatment may be biased by underlying differences in disease severity.", "followUp": "", "plainFinding": "Surgery gave better symptom relief and satisfaction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38580520/", "sourceText": "INTRODUCTION: There are very few French studies on hemorrhoidal disease and its management. PATIENTS AND METHODS: Prospective single-center study from July to December 2021 including 472 patients. RESULTS: Bleeding, prolapse and pain were the main reasons for consultation. Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%). After treatment, the bleeding score and prolapse score decreased significantly (P=0.002 and P≤0.0001, respectively), but improvement was more marked in the surgery group with a better rate of \"very good satisfaction\" (73% vs. 54%, P=0.003). Factors associated with likelihood of surgical treatment were: age>44years, hypertrophic perianal skin tags, high scores (Bristol>5, bleeding>5, prolapse>2), severe impact on quality of life, smoking and reading during bowel movements. We have developed an online application, which aims to assess the risk of requiring hemorrhoidal surgery. CONCLUSION: Less than 20% of patients who present with hemorrhoidal disease require surgical treatment, but it is associated with better effectiveness despite more complex postoperative consequences that sometimes motivate patient refusal. We have highlighted factors associated with surgical management, which can guide the practitioner in their therapeutic choices.", "provenance": [ { "field": "n", "quote": "Prospective single-center study from July to December 2021 including 472 patients." }, { "field": "population", "quote": "Bleeding, prolapse and pain were the main reasons for consultation." }, { "field": "intervention", "quote": "Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%)." }, { "field": "comparator", "quote": "Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%)." }, { "field": "primaryOutcome", "quote": "After treatment, the bleeding score and prolapse score decreased significantly (P=0.002 and P≤0.0001, respectively), but improvement was more marked in the surgery group with a better rate of \"very good satisfaction\" (73% vs. 54%, P=0.003)." }, { "field": "result", "quote": "improvement was more marked in the surgery group with a better rate of \"very good satisfaction\" (73% vs. 54%, P=0.003)" } ] }, { "id": "pmid:38151682", "pmid": "38151682", "doi": "10.1007/s13304-023-01741-y", "nctId": null, "pmcid": null, "title": "Thrombosed external hemorrhoids during pregnancy: surgery versus conservative treatment", "firstAuthor": "Medkova", "multipleAuthors": true, "journal": "Updates Surg", "year": 2024, "design": "prospective-cohort", "n": 53, "nField": "reported", "population": "pregnant women with thrombosed external hemorrhoids", "intervention": "surgical treatment (local excision or thrombectomy) for thrombosed external hemorrhoids", "comparator": "conservative treatment for thrombosed external hemorrhoids", "primaryOutcome": "pain and quality-of-life scores (VAS, CPGAS, SF-12) after treatment", "result": "Surgery gave faster pain relief and better quality-of-life scores by day 10 than conservative treatment; both were safe, and thrombectomy had a higher re-thrombosis rate than local excision", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This study is about surgical versus conservative treatment of thrombosed external hemorrhoids in pregnancy, not about manually pushing back a prolapsed hemorrhoid, so it does not answer the question asked.", "directness": "indirect", "relevanceNote": "", "limitations": "Only part of the study (the surgical subtypes) was randomized; the main conservative-vs-surgery comparison was observational, and randomization in the surgical arm was stopped early for ethical reasons.", "followUp": "10 days", "plainFinding": "Not about manual reduction of prolapse.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38151682/", "sourceText": "The management of thrombosed external hemorrhoids (TEH) during pregnancy is still under debate because of the fear of potential adverse effects on the fetus. This study aims to compare efficacy and safety of conservative versus surgical treatment of acute TEH in pregnant women. Furthermore, the outcome of two different surgical approaches was evaluated. This is a prospective observational study including a sub-analysis on two randomized groups of pregnant women affected by TEH. The primary outcome measured was the impact of conservative and surgical treatment defined in terms of VAS, clinical patient grading assessment scale (CPGAS) and the SF-12 questionnaire. In a randomized sub-analysis of the surgical treatment, the outcome of local excision (LE) versus thrombectomy (TE) was compared. Fifty-three patients entered the study. Twenty-six patients had conservative treatment and 22 underwent surgery. Within the surgical group, 8 were randomized for TE and 14 for LE. VAS, SF-12 and CPGAS improved in both groups after 3 and 10 days from the treatment. However, physical (PCS) and mental health (MCS) domains of the SF-12 and CPGAS showed a significant difference in favor of surgery on the 10th day (PCS: p < 0.002 and MCS: p = 0.03; CPGAS: p = 0.002). The surgical group showed an earlier significant reduction of pain on the 3rd day (p = 0.0004). In the surgical group, randomization was halted due to ethical concerns arising from a notable difference in the primary end point between subgroups during interim analysis. Specifically, the re-thrombosis rate was 38% (3/8) after TE and 7% (1/14) after LE. No complications occurred for either mothers or fetuses. Both surgical and conservative treatments are safe and effective. However, surgery allows a faster relief of anal pain. Thrombectomy is associated with higher risk of re-thrombosis when compared to local excision (clinicaltrials.gov ID number NCT04588467).", "provenance": [ { "field": "n", "quote": "Fifty-three patients entered the study." }, { "field": "population", "quote": "pregnant women affected by TEH" }, { "field": "intervention", "quote": "local excision (LE) versus thrombectomy (TE)" }, { "field": "comparator", "quote": "Twenty-six patients had conservative treatment and 22 underwent surgery." }, { "field": "primaryOutcome", "quote": "The primary outcome measured was the impact of conservative and surgical treatment defined in terms of VAS, clinical patient grading assessment scale (CPGAS) and the SF-12 questionnaire." }, { "field": "result", "quote": "The surgical group showed an earlier significant reduction of pain on the 3rd day (p = 0.0004)." }, { "field": "result", "quote": "Thrombectomy is associated with higher risk of re-thrombosis when compared to local excision" }, { "field": "followUp", "quote": "VAS, SF-12 and CPGAS improved in both groups after 3 and 10 days from the treatment." } ] }, { "id": "pmid:38110270", "pmid": "38110270", "doi": "10.3760/cma.j.cn441530-20231012-00128", "nctId": null, "pmcid": null, "title": "[Chinese expert consensus on the treatment of hemorrhoids by injection(2023 edition)]", "firstAuthor": "Anorectal Branch of Chinese Medical Doctor Association", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2023, "design": "guideline", "n": null, "nField": "not-reported", "population": "adults with hemorrhoids, usually aged 25-65", "intervention": "injection therapy for hemorrhoids", "comparator": "", "primaryOutcome": "expert recommendations on drug/dosage selection for hemorrhoid injection treatment", "result": "abstract does not report a quantitative outcome; it describes formation of expert consensus recommendations on types and application of injection treatments", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is an expert consensus statement summarizing recommendations rather than a study with measured outcomes, so it carries limited direct evidence weight.", "directness": "indirect", "relevanceNote": "", "limitations": "abstract does not address manual reduction of prolapsed hemorrhoids; it focuses on injection therapy consensus, not mechanical repositioning technique or safety.", "followUp": "", "plainFinding": "No info on manual reduction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38110270/", "sourceText": "Hemorrhoids is a common anorectal disease, usually occurring in middle-aged people aged 25-65 years old, clinical bleeding, swelling, prolapse, pain, itching and anal discomfort, and repeatedly attacks and aggravated gradually, seriously affecting the quality of life of patients. The treatment of hemorrhoids includes conservative, injection, ligation, and various surgical procedures. Injection therapy with a history of more than 150 years is simple to operate, easy to popularize and apply in grass-roots units, causes less intraoperative bleeding and fewer complications, and has reliable efficacy. As a result, it is favored by clinicians and patients. The injection treatment of hemorrhoids has been mentioned in various hemorrhoid treatment guidelines and consensus at home and abroad, but there is no special expert consensus for reference. Led by the Anorectal Physicians Branch of the Chinese Medical Doctor Association and the Colorectal Surgery Group of the Surgery Branch of the Chinese Medical Association, experts in related fields in China were invited to review the latest evidence-based medical evidence at home and abroad and conducted evidence quality assessment and recommendation strength classification according to the GRADE system. This paper attempts to make detailed recommendations on the types and application methods of the preparations commonly used in the injection treatment of hemorrhoids at home and abroad, and form the Chinese Expert Consensus on the Treatment of hemorrhoids by anal injection (2023 edition), aiming to guide the reasonable selection of drugs and dosage forms for hemorrhoidal injection treatment, and to provide reference for standardizing the use of different drugs and dosage forms, so as to improve the effectiveness and safety of clinical application of hemorrhoidal injection treatment.", "provenance": [ { "field": "population", "quote": "usually occurring in middle-aged people aged 25-65 years old" }, { "field": "intervention", "quote": "Injection therapy with a history of more than 150 years is simple to operate, easy to popularize and apply in grass-roots units" }, { "field": "result", "quote": "form the Chinese Expert Consensus on the Treatment of hemorrhoids by anal injection (2023 edition), aiming to guide the reasonable selection of drugs and dosage forms for hemorrhoidal injection treatment" }, { "field": "primaryOutcome", "quote": "make detailed recommendations on the types and application methods of the preparations commonly used in the injection treatment of hemorrhoids" } ] }, { "id": "pmid:37838461", "pmid": "37838461", "doi": "10.1016/j.suc.2023.05.014", "nctId": null, "pmcid": null, "title": "Anorectal Emergencies", "firstAuthor": "Drezdzon", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with anorectal emergencies including incarcerated hemorrhoids and rectal prolapse", "intervention": "bedside procedures and nonoperative management", "comparator": "surgical management", "primaryOutcome": "diagnosis and management approach for anorectal emergencies", "result": "most patients can be managed without surgery, but some conditions like gangrenous prolapse need surgery", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general review describing management approaches without specific data or outcomes for reducing a prolapsed hemorrhoid", "directness": "indirect", "relevanceNote": "", "limitations": "no specific data, numbers, or outcome results reported; abstract only lists topics covered", "followUp": "", "plainFinding": "General review, no specific results given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37838461/", "sourceText": "Anorectal emergencies are rare presentations of common anorectal disorders, and surgeons are often called on to assist in their diagnosis and management. Although most patients presenting with anorectal emergencies can be managed nonoperatively or with a bedside procedure, surgeons must also be able to identify surgical anorectal emergencies, such as gangrenous rectal prolapse. This article provides a review of pertinent anatomy; examination techniques; and workup, diagnosis, and management of common anorectal emergencies including thrombosed hemorrhoids, incarcerated hemorrhoids, anal fissure, anorectal abscess, rectal prolapse, and pilonidal abscess and unique situations including rectal foreign body and anorectal sexually transmitted infections.", "provenance": [ { "field": "population", "quote": "Anorectal emergencies are rare presentations of common anorectal disorders" }, { "field": "intervention", "quote": "most patients presenting with anorectal emergencies can be managed nonoperatively or with a bedside procedure" }, { "field": "comparator", "quote": "surgeons must also be able to identify surgical anorectal emergencies, such as gangrenous rectal prolapse" }, { "field": "primaryOutcome", "quote": "workup, diagnosis, and management of common anorectal emergencies including thrombosed hemorrhoids, incarcerated hemorrhoids, anal fissure, anorectal abscess, rectal prolapse, and pilonidal abscess" }, { "field": "result", "quote": "most patients presenting with anorectal emergencies can be managed nonoperatively or with a bedside procedure" } ] }, { "id": "pmid:37530049", "pmid": "37530049", "doi": null, "nctId": null, "pmcid": null, "title": "Treatment of haemorrhoids in pregnancy: A retrospective review", "firstAuthor": "Fiordaliso", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2023, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "pregnant women with hemorrhoids", "intervention": "various treatments for hemorrhoids in pregnancy (fiber, stool softeners, topical meds, anal packing, surgery)", "comparator": "", "primaryOutcome": "appropriate management approach for hemorrhoids during pregnancy", "result": "review summarizes that fiber, stool softeners and mild laxatives are generally safe, topical or oral treatments need caution, anal packing can help with bleeding, and surgery is reserved for severe cases", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative-style literature review without quality grading or statistical pooling, so its conclusions are weak evidence.", "directness": "indirect", "relevanceNote": "", "limitations": "No formal quality assessment, no mention of manual reduction technique for prolapsed hemorrhoids, and no numeric patient data reported.", "followUp": "", "plainFinding": "Reviews general hemorrhoid care in pregnancy.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37530049/", "sourceText": "AIM: Haemorrhoids are varicose veins of the rectum covered by mucosa at or near the anal canal. They are normally asymptomatic, can occur at any age and affect both males and females. Haemorrhoids are common in young women and commoner during pregnancy and the puerperium. In this review, we address the issue of the approach of the obstetrician and surgeons to haemorrhoids and their management. This is significant because there are currently no recommendations for pregnant patients with hemorrhoids. METHODS: The literature search comprised all the inherent published original papers; also abstract were included. No language selection was done. Search terms used were: \"hemorrhoid\", \"hemorrhoid therapy\", \"hemorrhoid in pregnancy\", \"hemorrhoid complication\". Data research was conducted using MEDLINE, EMBASE, Web of Sciences, Scopus, Clinical Trial. gov, OVID and Cochrane Library querying for all articles related to treatment of hemorrhoidis in pregnancy. RESULTS: Fiber supplement, stool softener and mild laxatives are generally safe for pregnant women. Topical medication or oral phlebotonics may be used with special caution because the strong evidence of their safety and efficacy in pregnancy is lacking. In case of massive bleeding, anal packing could be a simple and useful maneuver. Hemorrhoidectomy is reserved in strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding. KEY WORDS: Hemorrhoid, Hemorrhoid Therapy, Hemorrhoid in Pregnancy, Hemorrhoid Complication.", "provenance": [ { "field": "population", "quote": "Haemorrhoids are common in young women and commoner during pregnancy and the puerperium." }, { "field": "intervention", "quote": "Fiber supplement, stool softener and mild laxatives are generally safe for pregnant women." }, { "field": "intervention", "quote": "Topical medication or oral phlebotonics may be used with special caution" }, { "field": "intervention", "quote": "In case of massive bleeding, anal packing could be a simple and useful maneuver." }, { "field": "intervention", "quote": "Hemorrhoidectomy is reserved in strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding." }, { "field": "primaryOutcome", "quote": "we address the issue of the approach of the obstetrician and surgeons to haemorrhoids and their management" }, { "field": "result", "quote": "Fiber supplement, stool softener and mild laxatives are generally safe for pregnant women. Topical medication or oral phlebotonics may be used with special caution because the strong evidence of their safety and efficacy in pregnancy is lacking. In case of massive bleeding, anal packing could be a simple and useful maneuver. Hemorrhoidectomy is reserved in strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding." } ] }, { "id": "pmid:36472015", "pmid": "36472015", "doi": "10.19540/j.cnki.cjcmm.20220907.504", "nctId": null, "pmcid": null, "title": "[Expert consensus on clinical application of Fufang Jingjie for Fumigation and Washing]", "firstAuthor": null, "multipleAuthors": false, "journal": "Zhongguo Zhong Yao Za Zhi", "year": 2022, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with anal diseases such as hemorrhoids, prolapse, fissures and abscesses", "intervention": "Fufang Jingjie for Fumigation and Washing, a traditional Chinese medicine topical wash/fumigation treatment", "comparator": "", "primaryOutcome": "expert recommendations on usage, dosage and safety rather than a measured clinical outcome", "result": "The consensus describes the drug's functions and gives guidance on usage, dosage, adverse reactions and precautions, but does not report a measured clinical outcome or data on manually reducing a prolapsed hemorrhoid", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is an expert opinion/consensus statement based on literature review and clinical experience, not a controlled study with measured outcomes.", "directness": "indirect", "relevanceNote": "", "limitations": "No study design, no patient numbers, no comparator, and no outcome data are reported; it is an opinion-based consensus rather than original research, and it does not address manual reduction technique.", "followUp": "", "plainFinding": "Expert guidance, not about manual reduction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36472015/", "sourceText": "Fufang Jingjie for Fumigation and Washing is one of the commonly used and effective drugs for external fumigation and washing of traditional Chinese medicine, it has the functions of dispelling wind, drying and dampness, alleviating edema, and reducing swelling, relieving pain and relieving itching. It is widely used for the treatment of external hemorrhoids, mixed hemorrhoids, internal hemorrhoids prolapse and incarceration, anal fissures, perianal abscess, anal fistula acute attack, perianal eczema and other diseases. It has a significant effect on the uncomfortable symptoms caused by various anal diseases, such as swelling, pain, wet itching, falling and swelling, and many secretions, as well as various postoperative complications. Fufang Jingjie for Fumigation and Washing has been used in clinic for many years, it has a lot of research evidence and experience in clinical application. In order to further improve the clinicians' knowledge of Fufang Jingjie for Fumigation and Washing and guide clinical medication more reasonably, this consensus invites front-line clinical experts from anorectal department to compile, referring to the relevant clinical literature and guide, combining with the clinical treatment experience of experts, the function, usage, dosage, adverse reactions and points for attention were discussed of Fufang Jingjie for Fumigation and Washing. This consensus was formed to provide reference for the clinical application of Fufang Jingjie for Fumigation and Washing.", "provenance": [ { "field": "population", "quote": "widely used for the treatment of external hemorrhoids, mixed hemorrhoids, internal hemorrhoids prolapse and incarceration, anal fissures, perianal abscess, anal fistula acute attack, perianal eczema and other diseases" }, { "field": "intervention", "quote": "Fufang Jingjie for Fumigation and Washing is one of the commonly used and effective drugs for external fumigation and washing of traditional Chinese medicine" }, { "field": "primaryOutcome", "quote": "the function, usage, dosage, adverse reactions and points for attention were discussed of Fufang Jingjie for Fumigation and Washing" }, { "field": "result", "quote": "This consensus was formed to provide reference for the clinical application of Fufang Jingjie for Fumigation and Washing." } ] }, { "id": "pmid:35552375", "pmid": "35552375", "doi": "10.1093/bjsopen/zrac064", "nctId": null, "pmcid": "PMC9099087", "title": "Modified ligation procedure for prolapsed haemorrhoids versus stapled haemorrhoidectomy for the management of symptomatic haemorrhoids (MoLish): randomized clinical trial", "firstAuthor": "Yang", "multipleAuthors": true, "journal": "BJS Open", "year": 2022, "design": "rct", "n": 133, "nField": "reported", "population": "adults with symptomatic hemorrhoids needing surgery", "intervention": "modified ligation procedure for prolapsed hemorrhoids (a surgical technique)", "comparator": "stapled hemorrhoidectomy (another surgical technique)", "primaryOutcome": "how well the treatment worked, measured 6 months after surgery", "result": "the modified ligation surgery took longer but caused less pain, less temporary incontinence, lower symptom scores, and a higher cure rate at 6 months than stapled surgery", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but done at one center with some patients lost to follow-up, and it compares two surgeries rather than answering whether a prolapse can be manually pushed back in.", "directness": "indirect", "relevanceNote": "", "limitations": "single-center trial, two patients lost to follow-up, and it studies two surgical procedures rather than manual reduction of a prolapsed hemorrhoid", "followUp": "6 months", "plainFinding": "Compares two surgeries, not manual reduction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35552375/", "sourceText": "BACKGROUND: The aim of this study was to compare a modified ligation procedure versus stapled haemorrhoidectomy (SH) in patients with symptomatic haemorrhoids. METHODS: This randomized trial included patients with symptomatic haemorrhoids treated in Shanghai from May 2018 to September 2021. Eligible patients were randomly 1:1 assigned the modified ligation procedure for prolapsed haemorrhoids (MLPPH) and SH groups. The primary outcome was the assessment of efficacy at 6 months after the intervention. The operating time, incidence of complications, clinical effectiveness (pain, Wexner incontinence, haemorrhoid symptom severity (HSS) scores, and 6-month cure rate) were collected, and quality-adjusted life years (QALYs) were adopted as indicator for the cost-effectiveness analysis (CEA). RESULTS: Out of 187 patients screened, 133 patients were randomized (67 for MLPPH and 66 for SH). One patient in the MLPPH group was excluded, and two patients were lost to follow-up. The mean operating time was longer in MLPPH than in SH (57.42 min versus 30.68 min; P < 0.001). The median pain score was higher in SH than in MLPPH at postoperative day 3 (P = 0.018), day 7(P = 0.013), and day 14 (P = 0.003). The median Wexner incontinence score was higher in SH than in MLPPH at postoperative month 1 (P = 0.036) and month 3 (P = 0.035), but was similar in the two groups at month 6. In addition, the median HSS score was lower in MLPPH than in SH 6 months after surgery (P = 0.003). The 6-month cure rate was higher in MLPPH than in SH (P = 0.003). CEA showed lower mean costs in MLPPH than in SH (EUR 1080.24 versus EUR 1657.97; P < 0.001) but there was no significant difference in effectiveness (P = 0.181). However, MLPPH was cost-effective (incremental cost-effectiveness ratio, -120 656.19 EUR/QALYs). CONCLUSION: MLPPH was documented as a longer but cost-effective procedure, it provided lower short-term pain, and Wexner and HSS scores. Registration number: Chinese Clinical Trial Registry ChiCTR1800015928 (http://www.chictr.org.cn/searchproj.aspx).", "provenance": [ { "field": "n", "quote": "133 patients were randomized (67 for MLPPH and 66 for SH)" }, { "field": "population", "quote": "patients with symptomatic haemorrhoids" }, { "field": "intervention", "quote": "modified ligation procedure for prolapsed haemorrhoids (MLPPH)" }, { "field": "comparator", "quote": "stapled haemorrhoidectomy (SH)" }, { "field": "primaryOutcome", "quote": "The primary outcome was the assessment of efficacy at 6 months after the intervention." }, { "field": "result", "quote": "The mean operating time was longer in MLPPH than in SH (57.42 min versus 30.68 min; P < 0.001). The median pain score was higher in SH than in MLPPH at postoperative day 3 (P = 0.018), day 7(P = 0.013), and day 14 (P = 0.003)." }, { "field": "result", "quote": "The 6-month cure rate was higher in MLPPH than in SH (P = 0.003)." } ] } ], "faqs": [ { "q": "Can you push a hemorrhoid back in with your finger?", "a": "No study has tested whether doing this is safe or effective. One case report describes someone who pushed a prolapsed hemorrhoid back in and developed a serious infection, though she had a weakened immune system from cancer chemotherapy at the time." }, { "q": "How far do you push a hemorrhoid back in?", "a": "No study gives a distance or technique for this, so there is no evidence-based answer to how far is enough or too far. If a hemorrhoid will not go back in easily, forcing it is not supported by any research and a doctor should look at it instead." }, { "q": "What's the best position to push a hemorrhoid back in?", "a": "No study has compared positions for doing this, so there is no research-backed answer. This has simply not been tested." }, { "q": "Do hemorrhoids come back after being pushed back in?", "a": "No study followed people after manual reduction to see if prolapse returns. Studies of other treatments, like banding and surgery, do track recurrence over months, and recurrence does happen with those methods too, but that is a different situation." }, { "q": "Why do hemorrhoids keep coming back?", "a": "The studies found do not test the causes of recurrence after manual reduction specifically. They do show that even after banding or surgical procedures, some prolapse or hemorrhoid tissue can return, which suggests the underlying tissue changes are not always fully fixed by any single treatment." } ], "searchedAs": [ "how far to push hemorrhoids back in", "how to get hemorrhoids to go back in", "can you push a hemorrhoid back in with your finger", "how to get hemorrhoids back in", "can you push hemorrhoids back in", "best position to push hemorrhoid back in", "do hemorrhoids come back", "why hemorrhoids keep coming back" ], "patientTakeaway": "No research has tested whether pushing a prolapsed hemorrhoid back in with your finger is safe or actually helps. One report describes a person who developed a serious infection after doing this while her immune system was weakened by chemotherapy. If a hemorrhoid will not go back in, becomes very painful, turns dark or purple, or swells quickly, treat it as urgent and see a doctor or go to an emergency room instead of continuing to push on it; for ongoing prolapse, ask a doctor about banding or other treatments that have actually been studied.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "\"Hemorrhoids\"[Mesh] AND (prolapse*[tiab] OR \"manual reduction\"[tiab] OR reduc*[tiab] OR incarcerat*[tiab] OR strangulat*[tiab] OR thrombos*[tiab])" }, "pubmedQueryTranslation": "\"Hemorrhoids\"[MeSH Terms] AND (\"prolapse*\"[Title/Abstract] OR \"manual reduction\"[Title/Abstract] OR \"reduc*\"[Title/Abstract] OR \"incarcerat*\"[Title/Abstract] OR \"strangulat*\"[Title/Abstract] OR \"thrombos*\"[Title/Abstract])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Can you push a prolapsed hemorrhoid back in safely?", "description": "No study has tested whether pushing a prolapsed hemorrhoid back in is safe. We found 20 studies on related hemorrhoid treatments, not this exact question." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13", "gradeRules": "ev-1" }, "status": "published" }