The acute management of haemorrhoids

INTRODUCTION Although the acute thrombosis and strangulation of haemorrhoids is a common condition, there is no consensus as to its most effective treatment. METHODS A PubMed search was undertaken for papers describing the aetiology and treatment of the acute complications of haemorrhoids. RESULTS The anatomy and treatments for strangulated internal haemorrhoids and thrombosed perianal varices are discussed. Studies of the effectiveness and complications of conservative and operative treatments are reviewed. CONCLUSIONS Ambiguities exist in the terminology used to describe the two separate pathologies that make up the acute complications of haemorrhoids. These complications have traditionally been treated conservatively. There is evidence that early operative intervention for strangulated internal haemorrhoids is safe and effective. A suggested algorithm for treatment is given, based on the published literature.