Spinal Cord Injury Does Not Affect Haemorrhoid Treatment Outcome
A DGReview of :"Management of hemorrhoidal disease in patients with chronic spinal cord injury"
Techniques in Coloproctology

By Robert Short

The outcomes of the haemorrhoid treatments in patients with chronic spinal chord injuries is not impacted by the cause of the injury.

Dr D Scott and colleagues described their experience with the primary approach to haemorrhoidal disease in patients with chronic spinal cord injury, as seen at the Proctology Division of the Sheba Medical Center, Tel Aviv University Medical School, Ramat Gan, Israel. The investigators are based in the Division of Proctology at the Center.

Twenty nine patients (mean age 49 years) with paraplegia due to chronic spinal cord injury were treated, all had haemorrhoids. They mainly complained of rectal bleeding, difficulties in evacuation and discomfort or pain.

Treatment was as follows: 11 were treated conservatively (e.g. diet, hygiene, and laxatives); 18 underwent either banding or sclerotherapy of haemorroids or both. There were no major complications.

In reporting the results of the study, the researchers said: "In 28 of 29 patients, there was a significant reduction or cessation of bleeding and/or relief of symptoms. One patient required haemorrhoidectomy." Of the 28 successful treatments, 57 percent had partial reduction of bleeding or relief of symptoms, and 43 percent had a complete response. In contrast, only 15 percent of those treated conservatively had complete relief of symptoms and 82 percent had a partial response.

It was found that 59 percent of the patients who had banding/sclerotherapy had complete relief, and 41 percent had partial relief.

Overall, the researchers concluded, "The approach of banding or sclerotherapy of haemorrhoids in chronic spinal cord injury patients is safe and effective. When sensation of the perianal region is preserved, the outcome seems to be better. The cause of chronic spinal cord injury has no impact on treatment results. Patients with stage IV haemorrhoids seem to do worse than those with stages II and III."

Techniques in Coloproctology 2002; 6(1):19-22. "Management of hemorrhoidal disease in patients with chronic spinal cord injury"