Hemorrhoids

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Background

Internal and external hemorrhoids divided by pectinate (dentate) line
  • Pathologic state cccurs when internal or external hemorrhoid plexus become engorged, prolapsed, or thrombosed
  • Bleeding is usually limited (surface of stool, on toilet tissue, at end of defecation)
    • Passage of blood clots requires evaluation for colon lesions

Risk Factors

Types

Internal hemorrhoid chart

Internal hemorrhoid grades
Grade Description Diagram Picture
I
  • Luminal protrusion above dentate line
  • No prolapse
  • Painless bleeding
Piles Grade 1.svg Endoscopic view
II
  • Prolapse with spontaneous reduction
  • Prolapse during straining
Piles Grade 2.svg Hemrrhoids 04.jpg
III
  • Prolapse requires manual reduction
  • Prolapse during straining
Piles Grade 3.svg Hemrrhoids 05.jpg
IV
  • Prolapseā€”nonreducible
  • Can result in edema and strangulation
Piles Grade 4.svg Piles 4th deg 01.jpg

See Also

References