Hemorrhoid

Introduction
Hemorrhoid is a very common disease, which affects more than 80% of adults. In the past, hemorrhoid was considered as varicose vein. Recently, it is defined as a vascular cushion resulted from downward displacement of anal cushion, which are blood-filled spaces supported by a matrix of fibrous tissue and smooth muscle located in lower rectum. It is resulted from chronic straining, leading to local congestion due to various reasons such as chronic constipation, diarrhea, prolonged attempts when defecation, prolonged sitting and standing, lack of fibers in diet, etc. Local congestion will cause anal cushions to lose their attachment to the underlying rectal wall, leading to prolapse of internal hemorrhoidal tissue through the anal canal. As these hemorrhoids engorge, vasculature increases and the overlying mucosa become more friable. As a result, rectal bleeding occurs.
Hemorrhoid is classified as internal, external or internoexternal in relation to dentate line at lower rectum. Internal hemorrhoids are located above the dentate line, external hemorrhoids are located below the dentate line, while interno-external hemorrhoids are extended from above to below the dentate line

Clinical features
Hemorrhoids in many patients are found to be asymptomatic, and therefore no treatment is needed.
For symptomatic hemorrhoids, symptoms include:

1. Rectal bleeding – fresh bleeding is found after defecation that stain toilet paper and is separated from stool. Anemia will be results if prolonged bleeding occurs.
2. Prolapse – According to severity, prolapse is divided into different grading:
   
   
   • Grade 1 – bleeding without prolapse
   • Grade 2 – prolapse with spontaneous reduction
   • Grade 3 – prolapse with manual reduction
   • Grade 4 – incarcerated, irreducible prolapse


3. Perianal irritation (itchiness) and discharge (mucus)
4. Pain due to thrombosis of external hemorrhoid

Hemorrhoids in pregnancy
Hemorrhoids can also be found usually in the third trimester during pregnancy. It can be due to hormonal changes, obstruction of venous return by the gravid uterus and chronic straining secondary to constipation. Majority of symptoms can be resolved after delivery. These can be treated with conservative measures and intervention is rarely being indicated.


 


Reference: psclinic.com.hk/
The information aims to provide educational purpose only. Anyone reading it should consult
Surgery Specialist before considering treatment and should not rely on the information
above.