Comprehensive Hemorrhoid Treatment Protocol

Initial Assessment

Classification

• Grade I: Internal hemorrhoids, non-prolapsing
• Grade II: Prolapse with spontaneous reduction
• Grade III: Prolapse requiring manual reduction
• Grade IV: Irreducible prolapsed hemorrhoids

Key Diagnostic Steps

1. Digital rectal examination
2. Anoscopy
3. Sigmoidoscopy when indicated

Treatment Algorithm

Conservative Management (Grade I-II)

• Dietary Modifications

  • Increased fiber intake (25-35g/day)
  • Adequate hydration
  • Regular exercise

• Medical Treatment

  • Topical agents
    • Hydrocortisone 1-2.5%
    • Local anesthetics
  • Oral medications
    • Phlebotonics
    • NSAIDs for pain management

Office-Based Procedures (Grade II-III)

1. Rubber Band Ligation

   • Preferred for Grade II-III
   • Maximum 3 bands per session
   • 2-week interval between sessions

2. Sclerotherapy

   • 5% phenol in almond oil
   • Multiple injections (3-4 sites)

Surgical Management (Grade III-IV)

Indications for Surgery

• Failed conservative treatment
• Grade III-IV hemorrhoids
• Significant symptoms affecting QoL

Surgical Options

1. Hemorrhoidectomy

   • Ferguson (closed)
   • Milligan-Morgan (open)

2. Stapled Hemorrhoidopexy

   • PPH procedure
   • Lower post-op pain

Post-Treatment Care

Follow-up Schedule

• 1 week post-procedure
• 4 weeks for surgical cases
• As needed thereafter

Complications Management

• Pain control protocol
• Bleeding management
• Urinary retention prevention

Prevention Strategies

• Lifestyle modifications
• Regular screening
• Patient education