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internal hemorrhoids
Varicosities in the hemorrhoidal veins within the wall of the anus.
Classification:
- Grade 1: never appear at the anus
- Grade 2: protrude beyond the anus as an uncomfortable swelling, but return spontaneously
- Grade 3: remain outside the anus until returned by applied pressure
- Grade 4: permanently prolapsed
Etiology:
1) prolonged constipation
2) straining during defecation
3) pregnancy is a risk factor
4) diarrhea (uncommon)
Clinical manifestations:
1) seldom painful; pain generally indicates a fissure
2) hemorrhage
- bleeding at the end of defecation
3) perianal pruritus
Laboratory:
1) digital rectal examination
2) anoscopy
3) flexible sigmoidoscopy (before hemorrhoidectomy)
4) PT/PTT
Complications:
- heavy bleeding
- chronic unremitting hemorrhoidal prolapse
- strangulation
- mucosal ulceration
- thrombosis [3]
Management:
1) high fiber diet
2) stool softeners
3) warm sitz baths
4) phlebotonics may be of benefit [4]
5) sclerotherapy
6) forceful dilatation of the anus under general anesthesia
7) hemorrhoidectomy - especially if strangulation occurs
- office-based hemorrhoidal banding most effective [4]
Related
hemorrhoidal vein
General
hemorrhoids (piles)
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 353-54
- Geriatrics at your Fingertips, 13th edition, 2011
Reuben DB et al (eds)
American Geriatric Society
- Jacobs D
Hemorrhoids.
N Engl J Med 2014; 371:944-951. September 4, 2014
PMID: 25184866
http://www.nejm.org/doi/full/10.1056/NEJMcp1204188
- Davis BR, Lee-Kong SA, Migaly J et al
The American Society of Colon and Rectal Surgeons Clinical
Practice Guidelines for the Management of Hemorrhoids.
Diseases of the Colon & Rectum: March 2018. 61(3):284-292
PMID: 29420423
https://journals.lww.com/dcrjournal/Fulltext/2018/03000/The_American_Society_of_Colon_and_Rectal_Surgeons.7.aspx