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Minimally Invasive Treatment of Advanced Hemorrhoids and Ultrasound Imaging of Hemorrhoids

Hidenori Miyamoto

This review discusses the physiology, current non-operative and operative treatments and ultrasound imaging of hemorrhoids. Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions. The most common symptom is painless fresh rectal bleeding, but patients may also experience pruritus, swelling, prolapse, discharge, or soiling. The current patho-physiologies of hemorrhoids include the degenerative change of supportive tissue within the anal cushions, vascular hyperplasia, and hyper perfusion of the hemorrhoidal plexus. On the one hand hemorrhoidectomy has been the mainstay of surgical treatment, while more recently other approaches have been employed including stapled hemorrhoidopexy and Doppler-guided hemorrhoidal artery ligation (DGHAL). In Japan, on the other hand aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy has been the mainstay for all Goligher grade internal hemorrhoids as a minimally invasive non-operative treatment since 2000. As well, ultrasound imaging of hemorrhoids is improving and useful for the evaluation of treatment.