[Consensus hemorrhoids (Dutch Society for Surgery)].

On the initiative of the Dutch Surgical Society a consensus meeting was held on December 3rd, 1993 in Utrecht, the Netherlands by the National Organisation for Quality Assurance in Hospitals (CBO), on the diagnosis and treatment of haemorrhoids. The following statements were formulated. Haemorrhoids are vascular cushions, covered by mucosa, originating from the plexus rectalis superior, and are part of the normal anatomy of man. Complaints from haemorrhoids occur if they prolapse. The usual 4-grade classification of haemorrhoids has no direct impact on their treatment. Portal hypertension is not a cause of haemorrhoids. Blood loss, a sensation of prolapse, pruritus and soiling are non-specific symptoms of haemorrhoids. Anaemia may only be attributed to haemorrhoids after other pathology has been excluded. Acute massive anorectal blood loss is frequently caused by traumatic damage to the rectum. Anticoagulant therapy is a risk factor. The presence of unexplained perianal skin lesions neccessitates further proctologic investigation. Haemorrhoids are not palpable on rectal digital examination. In patients under 50 with anorectal blood loss and a history of haemorrhoids, a proctoscopic examination is sufficient. Anorectal blood loss in patients over 50 requires exclusion of higher pathology. The regulation of defaecation and eating habits can have a preventive effect on the development of haemorrhoids. Conservative measures form the basis of treatment for haemorrhoidal complaints. Local antihaemorrhoidal treatment can only be expected to give short-term relief and is not a causal therapy. Barron elastic band ligation and sclerosing, in addition to infrared coagulation are treatment modalities in the outpatient setting that are very effective, inexpensive and optimally patient-friendly.(ABSTRACT TRUNCATED AT 250 WORDS)