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At the heart of general practice since 1960

Two-week Ca rule is only helping minority

What GPs

can do for

Piles

Mr Karlheinz Jehle and Mr William Woods give an evidence-based update on effective management of haemorrhoids

Haemorrhoids are enlargements of the normal vascular cushions, which are essential in maintaining anal continence, and help differentiate between gas, liquid and solids in the anal canal. Weakening of supporting connective tissue leads to descent of the vascular cushion causing venous engorgement.

It has been suggested that constipation, diarrhoea, straining at stool and pregnancy contribute to the development of symptomatic haemorrhoids, although there is little evidence to support these beliefs.

What works?

What doesn't?

Cost-effectiveness

The bottom line

1Haemorrhoids are not painful (unless strangulated and prolapsed).

2 Anal pain is usually due to:

3Rectal bleeding in combination with anal symptoms 'protects' the patient from colorectal malignancy (Thompson, BMJ 2003).

4Refer to surgeon when you:

Karlheinz Jehle is research fellow in coloproctology and William Woods is consultant colorectal surgeon in the department of surgery at Worthing Hospital, West Sussex

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