Hemorrhoids are submucosal anal tissue cushions prone to bleeding.
Bright red, painless rectal bleeding during defecation is the most common presentation . Other symptoms include  anal itching, anal or pelvic pain especially during sitting, one or more palpable lumps that feel hard, congested and tender. There may also be complains of sudden, sharp pain during bowel movements that subsides eventually.
A detailed history and thorough physical examination is enough to identify as well as grade the disease.
Laboratory tests are seldom required. An occult blood test of stool and/or stool guaiac may be performed to confirm fresh bleeding (occult blood may point towards an upper gastrointestinal bleed).
A Doppler ultrasound and in some rare or severe cases, a CT scan may be conducted. A sigmoidoscopy or anoscopy may be performed to see the extent of hemorrhoids. Scoping is also encouraged in such patients to exclude cancer.
Diagnosis is mainly based on history and physical examination. Test result may aid in ruling out cancer and any other lower gastrointestinal tract pathology.
Conservative treatment is first line of management where the patient is advised to take plenty of fluids, and a high fibre diet . The use of stool softeners, particularly in patients who frequently suffer from constipation, can help in somewhat managing the condition. Non steroidal anti-inflammatory drugs (NSAIDs), corticosteroids like cortisone, and topical analgesics like lidocaine, may also help. The use of comfortable cotton undergarments may help prevent ulceration and infection.
Radical and definitive surgical treatment is indicated in approximately one out of ten patients with hemorrhoidal disease . The transanal hemorrhoidal dearterialization (THD) procedure is an effective treatment of hemorrhoidal disease . Other procedure such as stapling are also used to treat hemorrhoids.
Prognosis depends upon the grade of hemorrhoids. The lower the grade of hemorrhoids, the better is the prognosis. They can be graded according to the following criterias:
The exact cause of symptomatic hemorrhoids is unknown . There may be an alteration in the muscle tissue of the internal hemorrhoid plexus which is one of the causative factors for development of hemorrhoids . Venous stasis that is common during pregnancy, can be a risk factor. Constipation and forcible straining during stools can be a major predisposing factor. A combination of factors such as weakening of the vessel walls due to old age, undue straining due to long standing constipation, portal hypertension, childbirth and obesity may contribute to the development of symptomatic hemorrhoids.
Hemorrhoids are a very frequent complaint in outpatient departments and clinics. It is common in the older age group, and almost one half of individuals older than 50 years complain of the symptoms .
Hemorrhoids can occur at any age but the most common age group is 45-65 years. They are rare in people younger than 30.
They are common in whites, especially those belonging to a higher socioeconomic status.
An unusual change in the normal structure of hemorrhoid plexus is the pathology behind the disease . Hemorrhoids consist of dilated submucosal vessels that protrude beneath the anal or rectal mucosa. Due to exposure, they easily become subject to trauma which results in inflammation and thrombosis. Superficial ulceration may also occur.
Hemorrhoids, on the basis of their position, can be classified into 2 types:
When collateral vessels within the inferior hemorrhoidal plexus become dilated and inflamed, they are called external hemorrhoids. They are located below the anorectal line.
Dilation of the vessels of the superior hemorrhoidal plexus is termed as internal hemorrhoids. They are located within the distal rectum, along or above the anorectal line.
Hemorrhoids can be easily prevented simply be implementing a high fibre diet and drinking 8-10 glasses of water every day. Adding a higher content of whole grain and bulky fibrous food not only helps prevent hemorrhoids but also keeps the bowel in good shape. Stool softeners may also be used. By avoiding development of constipation and overdue straining during defecation, hemorrhoids can be prevented from occurring.
Hemorrhoids are dilated cushions of distal rectum and/or anal tissue that may or may not protrude out of the anal canal. They are uncomfortable and may be a source of bleeding; they can also thrombose and get inflamed, and are prone to painful ulceration . Due to one or more reasons, the blood vessels present in the hemorrhoidal plexus, located in the submucosa of the distal rectum and anal canal may get congested and dilated. This dilatation of blood vessels causes pain and often, bleeding. Sometimes, the dilatation may get so severe that it may proceed to prolapse. Hemorrhoids are very common, affecting about 5% of the population.
Hemorrhoids are engorged fibrovascular cushions lining the anal canal . They are swellings or dilatations of the blood vessels present inside the anal canal. They become congested and tender, due to certain causes, and result in discomfort during sitting and bowel movements and are prone to bleed.
Symptoms include sharp pain during bowel movements accompanied with fresh, bright red coloured blood. There may also be palpable, tender lumps within the anus, itching around the perineum, pelvic pain and sometimes a red coloured lump might appear to be falling or coming out of the anus during straining.
Conservative treatment includes dietery modifications, topical analgesics and stool softeners. Surgically, transanal hemorrhoidal dearterialization (THD) is a safe procedure and is, at present, one of the most effective treatments of hemorrhoidal disease .