Hemorrhoids: Difference between revisions

Latest revision as of 22:58, 4 January 2026

Background

Anatomy of the anus.

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

Constipation and straining at stool
Frequent diarrhea
Older age
IBD

Types

External hemorrhoid

Thrombosed external hemorrhoid

Internal hemorrhoid
- Originate above the dentate line
- Painless
External hemorrhoid
- Originate below the dentate line
- Painful

Internal hemorrhoid chart

Internal hemorrhoid grades
Grade	Description	Diagram	Picture
I	Luminal protrusion above dentate line No prolapse Painless bleeding
II	Prolapse with spontaneous reduction Prolapse during straining
III	Prolapse requires manual reduction Prolapse during straining
IV	Prolapse—nonreducible Can result in edema and strangulation

Treatment

Increase fiber
Sitz baths
Topical steroid - Hydrocortizone
Topical anti-spasmodic - Nifedipine
See also treatment by specific type:
- Internal hemorrhoid
- External hemorrhoid

References

Authors:

@@ Line 1: / Line 1: @@
+<languages/>
+<translate>
 ==Background==
-*Occur when internal/external hemorrhoidal plexuses become engorged, prolapse, thrombosed
-*Bleeding
-**Usually limited (surface of stool, on toilet tissue, at end of defecation)
-***Passage of blood clots requires that colonic lesions are ruled-out
-*Risk Factors
-**Constipation and straining at stool
-**Frequent diarrhea
-**Older age
-**IBD
-==Differential Diagnosis==
+</translate>
-{{Anorectal DDX}}
+{{Hemorrhoid background}}
+<translate>
 ==Types==
-===Internal===
-*Occur proximal to dentate line
-*Constant in their location: 2-, 5-, and 9-o'clock positions (when pt viewed prone)
-*Not readily palpable; best visualized through anoscope
-**May be palpable when prolapsed or thrombosed
-*Painless bleeding
-**Only painful when nonreducible, prolapsed hemorrhoids strangulate OR thrombose
-***Can lead to infection/necrosis
-*Prolapse
-**When prolapse occurs may develop mucous discharge and pruritus ani
-***If prolapse cannot be reduced progressive edema and strangulation may result
-***Other complications: severe bleeding, thrombosis, infarction, gangrene, sepsis
-====Classification====
-*Grade I: Luminal protrusion above dentate line; no prolapse; painless bleeding
-*Grade II: Prolapse with spontaneous reduction; prolapse during straining
-*Grade III: Prolapse requires manual reduction; prolapse during straining
-*Grade IV: Prolapse—nonreducible; can result in edema and strangulation
-====Treatment====
-#Conservative Tx
-##Indicated for mild to moderate symptomatic pts w/ grade 1 to grade 3 hemorrhoids
-##Stool softeners (psyllium), high-fiber diet, topical analgesics
-##Avoid laxatives causing liquid stool (can lead to cryptitis and anal sepsis)
-##Sitz bath 15min TID and after each bowel movement (decreases sphincter pressure)
-##Outpt surgical referral
-##Prolapsed hemorrhoid in pt w/ minimal symptoms can be manually reduced
-#Emergent surgical consultation and intervention is indicated for:
-##Continued and severe bleeding
-##Incarceration and/or strangulation (grade 4 hemorrhoids)
-##Intractable pain
-===External===
+[[File:M 44 anus 22.jpg|thumb|[[Special:MyLanguage/External hemorrhoid|External hemorrhoid]]]]
-*Occur distal to dentate line
+[[File:Perianal thrombosis 01.jpg|thumb|Thrombosed [[Special:MyLanguage/external hemorrhoid|external hemorrhoid]]]]
-*Can be seen at external inspection
+*[[Special:MyLanguage/Internal hemorrhoid|Internal hemorrhoid]]
-**More prominent with Valsalva
+**Originate above the dentate line
-*Thrombosed hemorrhoids (bluish-purple discoloration) cause painful defecation
+**Painless
-**Non-thrombosed hemorrhoids are usually painless
+*[[Special:MyLanguage/External hemorrhoid|External hemorrhoid]]
-***If pt c/o pain but hemorrhoids are not thrombosed suspect:
+**Originate below the dentate line
-****Perianal/intersphincteric abscesses
+**Painful
-****Anal fissures
+</translate>
-*Prolapse
+{{Internal Hemorrhoid Chart}}
-**Requires periodic reduction by the pt
+<translate>
+==Treatment==
+*Increase fiber
+*Sitz baths
+*Topical steroid - Hydrocortizone
+*Topical anti-spasmodic - Nifedipine
+*See also treatment by specific type:
+**[[Special:MyLanguage/Internal hemorrhoid|Internal hemorrhoid]]
+**[[Special:MyLanguage/External hemorrhoid|External hemorrhoid]]
-====Treatment====
-#Usually self-limiting w/ resolution in 1 week
-#Thrombosed:
-##Consider sitz baths and bulk laxatives if:
-###Thrombosis has been present >48 hr
-###Swelling has started to shrink
-###Pain is tolerable
-##Consider excision if:
-###Pt is not immunocompromised, child, pregnant woman, has portal HTN, coagulopathic
-###Thrombosis is acute (<48 hr)
-###Extremely painful
-###See [[External Hemorrhoid Excision]]
 ==See Also==
-*[[Anorectal Disorders]]
-==Source==
+*[[Special:MyLanguage/Anorectal disorders|Anorectal disorders]]
-Tintinalli
+==References==
+<references/>
 [[Category:GI]]
+</translate>