Haemorrhoids are vascular-rich connective tissue cushions located within the anal canal. Internal haemorrhoids lie proximal to the dentate line in the anal canal; external haemorrhoids are located distal to the dentate line.
Haemorrhoidal disease presents as painless rectal bleeding or sudden onset of perianal pain with a tender palpable perianal mass.
Diagnosis is confirmed with visualisation of the protruding tissue or anoscopic visualisation.
Treatment for all patients includes increasing dietary fibre. Rubber band ligation is a reasonable first-line treatment choice for grade 2 and 3 internal haemorrhoids. Other treatment options for grade 2 or 3 haemorrhoids include sclerotherapy, infrared photocoagulation, haemorrhoid arterial ligation, or stapled haemorrhoidopexy. Surgical haemorrhoidectomy may be considered for patients with large grade 3 haemorrhoids, but it is typically reserved for patients with grade 4 haemorrhoids.
Complications include recurrence or worsening of symptoms, excessive bleeding, non-reducible prolapse, and, rarely, pelvic sepsis.
Haemorrhoidal cushions are normal anatomical 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.
History and exam
Senior Lecturer and Consultant in Colorectal Surgery
National Bowel Research Centre (NBRC)
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).
Senior Fellow in Colorectal Surgery
Colorectal Surgery & Pelvic Floor Services
Royal London Hospital
Barts Health NHS Trust
JDJ declares that he has no competing interests.
Professor of Surgery
Ninewells Hospital & Medical School
University of Dundee
RJCS declares that he has no competing interests.
Dr Mohamed A. Thaha and Professor Robert J.C. Steele would like to gratefully acknowledge Dr Kurt G. Davis, the previous contributor to this topic.
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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