Up to 5% of the patients of a general practitioner have terminal bowel disease, most frequently
hemorrhoids. Any patient who presents with ano-rectal discomfort or anal blood losses should undergo thorough proctologic examination including rectoscopy. Digital palpation is insufficient as only 10% of rectal
carcinomas can be reached. The treatment of
hemorrhoids should be started by instructing the patient on anal hygiene, to be followed only then by symptomatic application of creams or
suppositories. If these symptomatic measures fail, treatment by
injections is indicated. This method may be complicated by localized or extensive
necrosis of the rectal mucosa, the cause of which is assumed to be an immunologic event resembling the
Arthus phenomenon in which bacterial or possibly pharmacologic substances may act as
antigens. Therefore, a method of provoking coagulation without using foreign substances was sought.
Thermocoagulation by the infrared coagulator appears to be a suitable method: first experience tends show equal efficacy with coagulation by injection treatment. Prolapsing
hemorrhoids are still treated by barron
ligation. The precise management of each therapeutic approach is described.