This is a 55 year old lady undergoing flexible sigmoidoscopy to investigate her PR bleeding. This lesion was found on retroverting the endoscope in the rectum.
WHAT IS THE MOST LIKELY DIAGNOSIS?
■ Fibro-epithelial polyp
■ Inflammatory polyp
■ Squamous cell carcinoma
The three anal vascular cushions (at 3, 7 and 11 O’clock) help with maintaining continence.
When these cushions become abnormally enlarged, due to for example excessive straining (chronic constipation), age, or raised intra-abdominal pressure (such as pregnancy, chronic cough, or ascites), they become pathological.
Haemorrhoids are classified as follows:
After a flexible sigmoidoscopy has excluded a low colonic lesion, most cases can be managed conservatively by reassurance, preventing constipation and topical analgesia.
Alternatively, 1st and 2nd degree haemorrhoids can be treated with rubber-band ligation (RBL). A surgical haemorrhoidectomy may be indicated in the case of 3rd degree and 4th degree haemorrhoids. The serious complication of hemorrhoidectomy is anal stenosis which occurs after 2-4% of operations. However, I have the impression that this procedure is performed far less now than in the past but have not seen any data to actually confirm this impression.