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The most effective treatment for severe hemorrhoids is surgical removal, according to a new study.

The finding contradicts the widely-held belief that rubber-band ligation -- the practice of cutting off circulation, causing the hemorrhoid to wither away -- is better.

Dr. Venkatesh Shanmugam, a clinical research fellow in the department of surgery at the Aberdeen Royal Infirmary in Scotland, said that rubber-band ligation has a good success rate -- ranging from 70 to 95 per cent -- and a lower rate of complications but that surgery "achieved a better overall cure rate."

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In other words, patients who undergo surgery rarely require further treatment, something that cannot be said of other methods.

Hemorrhoids -- also known as piles -- are a painful condition in which the veins around the anus or lower rectum are swollen and inflamed. Piles can result from straining to move stool, chronic constipation, diarrhea, and anal intercourse. Pregnant women and the elderly also suffer frequently from hemorrhoids. Men are more likely than women to experience the condition, largely because they tend to eat far less fibre.

The new research, a review of existing studies, is published in The Cochrane Library, a publication of an international organization that evaluates medical research.

Dr. Shanmugam said that, despite the fact that hemorrhoids are a common condition -- one that will affect about 90 per cent of people at some point -- there is very little research on the topic. His review included only three studies with a total of 206 patients.

Hemorrhoids are classified by degree of severity, with first degree the least serious and fourth degree the most severe.

The review suggests that the best treatment for less serious cases is dietary change, notably a high-fibre diet. For second-degree hemorrhoids, rubber-band ligation is recommended, while surgery is tapped as the treatment of choice for third- and fourth-degree cases.

In the review, Dr. Shanmugam did not recommend the use of popular ointments such as Preparation H, saying "there is little objective evidence of their efficacy."

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The review did not make any recommendations either on a new procedure called stapled hemorrhoidopexy, in which a surgical stapling device is used to remove hemorrhoids, because there is not yet enough research on the method.

Anecdotally, patients report that it is less painful than traditional surgery, in which hemorrhoids are removed surgically, or burned off with a laser.

Rubber-band ligation is popular because it can be done in a doctor's office, without anesthesia. The procedure results in discomfort for a couple of days -- though it is rarely more painful than the hemorrhoids themselves. The major drawback of ligation is that it shrinks hemorrhoids but does not eliminate them entirely, so they can recur.

Dr. Scott Thornton, an assistant professor at Yale University School of Medicine in New Haven, Conn., said that he disagreed with the conclusions of the review because it failed to take into account the pain and complications of surgery, which are major factors for patients.

"My own view is that rubber-band ligation is pretty darn effective," he said. "I'll bet that if the reviewers were taking care of hemorrhoids of their own, they would opt for rubber-band ligation because there is a significant amount of pain involved with excisional hemorrhoidectomy [surgical removal of hemorrhoids]"

While hemorrhoids are bothersome, they are not a serious or life-threatening condition. Still, it is recommended that people suffering from the condition see a doctor, particularly if there is bleeding from the rectum or blood in the stool, which could be signs of much more serious digestive diseases such as colorectal cancer.

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