LAUSR

Patients having severe anemia (Hb < 7 g/dl) due to bleeding hemorrhoids can pose a serious therapeutic challenge [1, 2]. Initially, they are managed by blood transfusions plus an office procedure. If bleeding persists after the office procedure, then an urgent surgery is required [1]. Many of these patients have grade I–II hemorrhoids, and unfortunately, they end up getting operated even for early hemorrhoids [1]. The whole situation becomes complex if the patient is on anti-coagulants which cannot be stopped [1, 2]. In such patients, office procedures cannot be relied upon, and surgery is extremely risky. Even oral iron supplementation can cause constipation or diarrhea which further increases the risk of bleeding. Both oral and parenteral iron would take 2–3 weeks to correct anemia. Therefore, blood transfusion becomes necessary which has its own hazards. A novel yet simple management protocol, LOOP can be tried in such patients. L—Liquid diet having zero fiber and an enema on the first day to evacuate rectum O—Oral rehydration solution (ORS) O—Oral vitamin and iron supplementation P—Protein supplementation (50–60 g/day) Principle