HEMORRHOID DISEASE: DIAGNOSIS TREATMENT AND COMPLICATION MANAGEMENT

Hemorrhoidal_Disease_Bahadir_Egekapak

HEMORRHOIDAL DISEASE IN CHILDREN AND ADOLESCENTS

Lütfiye İdil Emral

Beştepe State Hospital, Department of Pediatrics, Ankara, Türkiye

Emral lİ. Pain Management in Hemorrhoidal Disease. In: Ege B, editor. Hemorrhoidal Disease: Diagnosis, Treatment and Complication Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.147-154.

ABSTRACT

Hemorrhoidal disease in children and adolescents, though rare, is a significant condition that can cause considerable symptoms and complications. Hemorrhoids are normal vascular structures in the anal canal, classified into internal, external, and mixed types based on their anatomical location and characteristics. Internal hemorrhoids, located proximal to the dentate line, are often asymptomatic or present with painless bleeding and prolapse, while external hemorrhoids, situated distal to the dentate line, tend to be more painful, especially when thrombosed. The pathophysiology of hemorrhoidal disease is not fully understood but is believed to involve the deterioration of soft tissues supporting the anal cushions, leading to venous dilation, prolapse, and a loss of the normal regulatory mechanism of the anal sphincter. Several risk factors have been identified in pediatric patients, including chronic constipation, poor dietary habits. Additionally, portal hypertension is a major risk factor, with up to 35% of children with this condition showing signs of hemorrhoidal disease or anorectal varices. While hemorrhoidal disease is rare in children, it becomes more common during adolescence. The diagnosis is primarily clinical, with a thorough history and physical examination being the cornerstone of identification. Hemorrhoids typically present with bright red bleeding, prolapse, and discomfort, and are often associated with chronic constipation. In cases where hemorrhoids are suspected, it is essential to differentiate them from other conditions like anal fissures, rectal prolapse, and anorectal varices, particularly when bleeding is present. Management strategies for hemorrhoidal disease include conservative treatments such as dietary modifications, increased fiber intake, adequate hydration, and topical medications, which are effective in early-stage disease. If conservative measures fail, minimally invasive techniques like sclerotherapy and rubber band ligation may be considered. For more advanced cases, particularly in adolescents, surgical interventions such as hemorrhoidectomy may be necessary. The treatment approach should be tailored to the patient’s age, clinical presentation, and the severity of the disease. Despite being uncommon in children, hemorrhoidal disease requires careful diagnosis and management, with close attention to underlying conditions such as portal hypertension. understanding the complexities of this condition is crucial for pediatric care providers to ensure optimal treatment outcomes.

Keywords: Hemorrhoid; Adolescent; Child; Constipation; Conservative treatment

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