Hemorrhoids are vascular-rich connective tissue cushions located within the anal canal. Internal hemorrhoids lie proximal to the dentate line in the anal canal; 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 for all patients includes increasing dietary fiber. Rubber band ligation is a reasonable first-line treatment choice for grade 2 and 3 internal hemorrhoids. Other treatment options for grade 2 or 3 hemorrhoids include sclerotherapy, infrared photocoagulation, hemorrhoid arterial ligation, or stapled hemorrhoidopexy. Surgical hemorrhoidectomy may be considered for patients with large grade 3 hemorrhoids, but it is typically reserved for patients with grade 4 hemorrhoids.
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.
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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