[Diagnosis and therapy of hemorrhoids. New knowledge in sclerotherapy].

UNLABELLED: FUNDAMENTAL REMARKS: Successful treatment of hemorrhoids stands and falls with the correct diagnosis.

MAIN TOPICS: Where conservative treatment measures are justified and surgical intervention can be foregone, new studies on the sclerotherapy of hemorrhoids have led to a change in therapeutic objectives. Accordingly, in the case of enlarged symptomatic hemorrhoids an attempt should not be made primarily to reduce their size; rather, the usually caudally displaced hemorrhoidal convolutes should be fixed again above the dentate line. This is achieved by injecting the sclerosant not as previously into the center of the hemorrhoid convolute, but into the base between hemorrhoids and the adjacent muscular layer. This does not lead to destruction of the hemorrhoids with possible impairment of their function, but to the desired fixation. In this way, irrespective of the degree of the hemorrhoidal disease the danger that, on defecation, the hemorrhoids are forced into the anal channel, is avoided. If the hemorrhoids cannot be fixed in the way described, only surgical measures will lead to success.

CONCLUSIONS

Sclerotherapy of hemorrhoids should not be aimed at shrinking, but fixing them. Should the objective not be achieved after two or three treatment sessions, surgery should be considered.