Hemorrhoids: A plea for nonsurgical treatment

There are numerous different forms of treatment for hemorrhoids. Conservative therapy with suppositories and stool softeners is usually effective. However, many patients still come to surgery and it is unclear which of the many methods of active treatment should be used. Surgery is still widely performed, but other possible methods include injection therapy, elastic band ligation, cryosurgery, anal dilatation and lateral subcutaneous sphincterotomy. The scanty literature on comparative controlled trials of these methods is reviewed. These studies indicate that formal hemorrhoidectomy should rarely be necessary, as results of elastic band ligation and anal dilatation compare very favorably with surgery. It is suggested that elastic band ligation and anal dilatation are very effective forms of treatment in patients not responding to conservative therapy.