A NEW METHOD OF EVALUATING HEMORRHOIDS WITH THE RETROFLEXED FIBEROPTIC COLONOSCOPE

Background: The conventional classification of the degree of hemorrhoi ds does not consider the severity of hemorrhage. The purpose of this s tudy was to establish a new objective method for evaluating hemorrhoid s in close relation to the main symptoms, hemorrhage and prolapse, as observed through a retroflexed colonoscope in the rectum. Methods: The subjects were 531 consecutive patients who complained of symptoms rel ated to the rectum or the anus. The degree of mucosal elevation of the rectal columns, changes in color (the existence and degree of red col or sign, dilated vein, and white area), and the existence and size of hypertrophied anal papillae were evaluated by colonoscopy. Results: Re d color sign was the finding closely related to hemorrhage (p < 0.0001 ). Dilated vein, white area, and a large hypertrophied anal papilla we re related to prolapse (p < 0.0001). The degree of mucosal elevation o f the rectal columns was related to both hemorrhage and prolapse (p < 0.0005, p < 0.05). Conclusion: Retroflexing the colonoscope intrarecta lly facilitated identification of findings in the anal canal related t o hemorrhage and prolapse, which are the clinical manifestations of he morrhoids.