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


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
 Endoscopic view
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


References

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