Hemorrhoids

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

See Also

• Anorectal disorders