![]() Preventive Services Task Force guidelines 2 – 4 Hemorrhoids are the most common cause and often resolve with fiber supplementation grade III and IV hemorrhoids are more likely to benefit from surgical therapiesĮvaluate for malignancy in patients 50 years and older who have not had screening per U.S. Upper or lower gastrointestinal tract bleeding ![]() Two RCTs with consistent data showing improved symptoms and quality of life Patients with fecal incontinence should be referred for biofeedback. Meta-analysis of four RCTs showing less effectiveness and more complications compared with other treatments Manual stretching should not be used to treat anal fissures. Multiple meta-analyses, including a Cochrane review, showing symptom benefit and resolution of fissures In addition to measures aimed at softening the stool, chronic anal fissures should be treated with topical nitroglycerin 0.4% ointment, topical calcium channel blockers, or onabotulinumtoxinA (Botox) injections. 2, 19Įxpert opinion and consensus guidelines in the absence of clinical trials Two smaller RCTs and a prospective observational trial showing symptom benefit in several different conditionsĪlong with dietary modification, topical treatments such as flavonoids, steroids, analgesics, and antiseptics may be used to treat hemorrhoids. Colostomy can help improve quality of life for patients with severe fecal incontinence.ĭietary modification including adequate fiber intake improves quality of life and is recommended in the treatment of multiple benign anal conditions including hemorrhoids, anal fissures, functional rectal pain, and fecal incontinence. Biofeedback is a first-line treatment for fecal incontinence, but antidiarrheal agents are useful if diarrhea is involved, and fiber and laxatives may be used if impaction is present. Patients with rectal prolapse should be referred for surgical evaluation. ![]() Condylomata can be managed with topical medicines, excision, or destruction. Patients with superficial perianal abscesses not involving the sphincter should undergo office-based drainage patients with more extensive abscesses or possible fistulas should be referred for surgery. Patients with functional rectal pain should be treated with warm baths, fiber supplementation, and biofeedback. Chronic anal fissures should be treated with topical nitrates or calcium channel blockers, with surgery for patients who do not respond to medical management. ![]() Treatment of acute anal fissures with pain and bleeding involves adequate fluid and fiber intake. Capsaicin cream and tacrolimus ointment are effective for recalcitrant cases. Perianal pruritus should be treated with hygienic measures, barrier emollients, and low-dose topical corticosteroids. Acutely thrombosed external hemorrhoids should be excised. Patients who do not improve and those with large high-grade hemorrhoids should be referred for surgery. The primary treatment for hemorrhoids is fiber supplementation. History and examination, including anoscopy, are usually sufficient for diagnosing these conditions, although additional testing is needed in some situations. Although these are benign conditions, symptoms can be similar to those of cancer, so malignancy should be considered in the differential diagnosis. Common anorectal conditions include hemorrhoids, perianal pruritus, anal fissures, functional rectal pain, perianal abscess, condyloma, rectal prolapse, and fecal incontinence. ![]()
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