Therapeutic standards for haemorrhoidal disease in Europe and the United States

Abstract

Haemorrhoidal disease is the most common anorectal reason for medical appointments. The grade of the disease is an important aspect in qualification for treatment. Banov grading system, which distinguishes 4 grades of disease based on the degree of haemorrhoid prolapse, is the most commonly used classification system. While the majority of researchers are in agreement as to the use of conservative treatment in the initial stage of the disease, the treatment of grade II and III patients raises much controversy, and the developed therapeutic standards differ from country to country. We present the therapeutic standards applied in the United States, some European countries and in Japan. The initial conservative treatment of the disease is common for the presented algorithms of therapeutic management. Interestingly, infrared photocoagulation, which is very rarely performed in Poland, has its permanent place in the treatment of moderately advanced hemorrhoidal disease in most European algorithms. Some of expert opinions seem extreme, e.g. adding sphincterotomy to haemorrhoidectomy to reduce postoperative pain. We also propose our own therapeutic algorithm, which considers Polish realities.