internal hemorrhoids
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Introduction
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
- prolonged constipation
- straining during defecation
- pregnancy is a risk factor
- diarrhea (uncommon)
Clinical manifestations
- seldom painful; pain generally indicates a fissure
- hemorrhage
- bleeding at the end of defecation
- perianal pruritus
Laboratory
Complications
- heavy bleeding
- chronic unremitting hemorrhoidal prolapse
- strangulation
- mucosal ulceration
- thrombosis[3]
Management
- high fiber diet
- stool softeners
- warm sitz baths
- phlebotonics may be of benefit[4]
- sclerotherapy
- forceful dilatation of the anus under general anesthesia
- hemorrhoidectomy - especially if strangulation occurs
- office-based hemorrhoidal banding most effective[4]
More general terms
Additional terms
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
- ↑ 3.0 3.1 Jacobs D Hemorrhoids. N Engl J Med 2014; 371:944-951. September 4, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25184866 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1204188
- ↑ 4.0 4.1 4.2 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: https://www.ncbi.nlm.nih.gov/pubmed/29420423 https://journals.lww.com/dcrjournal/Fulltext/2018/03000/The_American_Society_of_Colon_and_Rectal_Surgeons.7.aspx