Hemorrhoids are vascular-rich connective tissue cushions located within the anal canal.
Internal hemorrhoids lie proximal to the dentate line in the anal canal, whereas external hemorrhoids are located distal to the dentate line.
Hemorrhoidal disease presents as painless rectal bleeding or sudden onset of perianal pain with a tender palpable perianal mass.
Diagnosis is confirmed with visualization of the protruding tissue or anoscopic visualization.
Treatment includes increasing dietary fiber, rubber band ligation, infrared photocoagulation, sclerotherapy, or surgical hemorrhoidectomy.
Complications include recurrence or worsening of symptoms, excessive bleeding, nonreducible prolapse, and, rarely, pelvic sepsis.
Hemorrhoidal cushions are normal anatomic structures located within the anal canal, usually occupying the left lateral and right anterior and posterior positions. As they enlarge, they can protrude outside the anal canal causing symptoms.
Senior Lecturer in Colorectal Surgery
Academic Surgical Unit
National Centre for Bowel Research & Surgical Innovation (NCBRSI)
Centre for Digestive Diseases
Barts and The London School of Medicine & Dentistry
Queen Mary University of London
MAT held a clinical research training fellowship (2000-2003) and has obtained research grants (2000-2006) from Ethicon Endo-Surgery (UK and Europe).
Professor of Surgery
Ninewells Hospital & Medical School
University of Dundee
RJCS previously obtained a research grant from Ethicon Endo-Surgery (UK).
Dr Mohamed A. Thaha and Professor Robert J.C. Steele would like to gratefully acknowledge Dr Kurt G. Davis, the previous contributor to this monograph. KGD declares that he has no competing interests.
Honorary Clinical Research Fellow
Division of Surgery
Reproductive Biology and Anaesthetics
St Mary's Hospital
GR declares that he has no competing interests.
Clinical Research Fellow
Department of Biosurgery and Surgical Technology
St Mary's Hospital
AVR declares that he has no competing interests.
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