Hemorrhoids overview
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Hemorrhoids overview On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Hemorrhoids are varicosities or swelling and inflammation of veins in the rectum and anus. The rectum is the last part of the large intestine leading to the anus. The anus is the opening at the end of the digestive tract where bowel contents leave the body. External hemorrhoids are located under the skin around the anus. Internal hemorrhoids develop in the lower rectum. Internal hemorrhoids may protrude, or prolapse, through the anus. Most prolapsed hemorrhoids shrink back inside the rectum on their own. Severely prolapsed hemorrhoids may protrude permanently and require treatment.
Historical Perspective
Hemorrhoids were first discovered by ancient Egyptians more than 3700 years ago.
Classification
Hemorrhoids can be classified according to their site into external and internal hemorrhoids. Furthermore, internal hemorrhoids can be graded according to severity into 4 grades.
Pathophysiology
Hemorrhoids are developed due to combination of genetic predisposition (weak rectal veins) and following certain diet and defecation habits.
Causes
Hemorrhoids may be caused by caused by factors that increase the pressure in the rectal veins such as chronic cough, chronic constipation and straining.
Differentiating Hemorrhoids from other Diseases
Hemorrhoids should be differentiated from other diseases causing anal discomfort and pain with defaecation such as rectal cancer, anal fissure, anal abscess, anal fistula.
Epidemiology and Demographics
In the USA, the prevalence is about 4.4% while only about 500,000 patients in the U.S. are medically treated for massive hemorrhage, with 10 to 20% of them requiring surgeries. [1]
Risk Factors
Common risk factors in the development of hemorrhoids are excessive straining, sitting or standing for long periods of time, pregnancy, and Chronic constipation.
Screening
According to the USPSTF, screening for hemorrhoids is not recommended.
Natural History, Complications, and Prognosis
If left untreated, hemorrhoids may progress to develop strangulation, anemia or fecal incontinence. Common complications of hemorrhoids include secondary infection, thrombosis or strangulation. Prognosis is generally excellent and most cases respond to non surgical treatment. However, surgery gives the best prognosis with the least recurrence rate.
History and Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
Eating a high-fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining.