Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-ADDING HEMORRHOID TREATMENT TO YOUR SERVICE LINE

Video Transcription

Video Summary

The speaker argues that most anorectal problems can be diagnosed and treated in a gastroenterology office, reducing unnecessary referrals to surgeons. Hemorrhoids are the most common anorectal condition and can often be managed efficiently and profitably in clinic, especially with anoscopy, which is presented as a simple, essential tool for visualizing the anal canal (beyond what endoscopy shows). Proper evaluation includes careful perianal inspection (to avoid missing cancer, fissures, condyloma, thrombosis), digital rectal exam to assess tenderness and pelvic floor function, and anoscopy to identify hemorrhoid columns.<br /><br />Hemorrhoids are classified as internal vs external (relative to the dentate line) and graded by prolapse severity; fourth-degree typically requires surgery, while many third-degree cases respond to office banding. Rubber band ligation is emphasized as the most effective nonoperative treatment, with key technique points: place bands well above the dentate line, capture only mucosa (not muscle), and “massage” or remove a painful band if placed too low. Infrared coagulation is less effective for prolapse but useful for patients on antiplatelets, pregnant patients, or those intolerant of banding. The talk also covers office lancing of thrombosed external hemorrhoids within 72 hours for rapid pain relief, plus counseling on fiber, fluids, limiting toilet time, and addressing dyssynergia when constipation persists.

Keywords

anorectal disorders

hemorrhoids

anoscopy

rubber band ligation

infrared coagulation

thrombosed external hemorrhoid lancing

constipation management (fiber, fluids, pelvic floor dyssynergia)