hemorrhoids (piles)
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Classification
- external hemorrhoids; occur below the dentate line (pectinate line)
- internal hemorrhoids: occur above the dentate line
Etiology
- enlarged veins within the rectum (internal) or around the perianal region (external)
Pathology
- collections of submucosal, fibrovascular, arteriovenous sinusoids, that are part of the normal anorectum[2]
- vascular cushions that support the muscle of the anal sphincter by swelling up as needed to support stool continence
- prolapsed hemorrhoids are internal hemorrhoids that protrude out of the rectum[2]
Clinical manifestations
- may be associated with hematochezia or BRBPR[6]
Differential diagnosis
Management
- dietary & lifestyle measure to soften stool (first line grade 1 & 2)[7]
- adequate fluids
- increased dietary fiber
- exercise
- phlebotonics may be of benefit[5]
- avoid constipation, straining & prolonged time on toilet
- stool softener, laxative as needed (see constipation)
- hemorrhoidectomy with office-based hemorrhoidal banding when medical therapy inadequate[5]
More general terms
More specific terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 353-54
- ↑ 2.0 2.1 2.2 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
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018. 2021.
- ↑ Rivadeneira DE, Steele SR, Ternent C et al Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum. 2011 Sep;54(9):1059-64 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21825884 (corresponding NGC guideline withdrawn Nov 2016)
- ↑ 5.0 5.1 5.2 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
- ↑ 6.0 6.1 NEJM Knowledge+ Gastroenterology
- ↑ 7.0 7.1 7.2 Wald A, Bharucha AE, Limketkai B et al ACG Clinical Guidelines: Management of Benign Anorectal Disorders. Am J Gastroenterol. 2021 Oct 1;116(10):1987-2008. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34618700
- ↑ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Hemorrhoids https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids