Hemorrhoid

an enlarged (varicose) vein in the mucous membrane inside or just outside the rectum; called also pile.

Internal hemorrhoids usually are first noticed when minor bleeding occurs with defecation. Pain occurs rarely, unless there is an associated disorder such as an anal fissure, thrombosis, or strangulation of the affected vein. External hemorrhoids produce varying degrees of pain, feelings of pressure, itching, irritation, and a palpable mass. Bleeding occurs only if the external hemorrhoid is injured or ulcerated and begins to break down.

Hemorrhoids are caused by increased pressure on the veins of the anus. Prolonged sitting, constipation, and hard, dry stools that are difficult to pass can lead to straining and sitting at stool for long periods of time, all of which add pressure on the anal veins. Failure to follow through on the urge to defecate can also lead to hemorrhoids. In women, probably the single most common cause is pregnancy.

External hemorrhoids can be treated by local applications of cold and an astringent cream, by sitz baths, and by avoidance of constipation. Internal hemorrhoids may require sclerosing or cryosurgery to obliterate the affected tissue. More advanced, chronic hemorrhoids usually must be removed surgically by ligation and excision (hemorrhoidectomy) or by barron ligation.

Veins of the internal or external hemorrhoidal plexuses and the immediately surrounding tissues. Hemorrhoids are most often referred to only when diseased (i.e., enlarged, painful, bleeding). Other anorectal conditions (e.g., anal fissure, condylomata, anal cancers) may produce similar symptoms and must be distinguished from hemorrhoids by appropriate examination. Synonym: pilesillustration;

Treatment

Therapy depends on the severity of the symptoms, not the extent of the hemorrhoids. In many instances, the only therapy required is improvement in anal care, adherence to appropriate fluid intake and diet if necessary, and administration of stool softeners to prevent straining to have a bowel movement. Measures to reduce local pain and congestion include the temporary use of local anesthetic agents, lubrication, cold compresses, warm sitz baths, and thermal packs. The necessity of surgery or other modalities of direct intervention (e.g., latex band ligation, sclerotherapy, cryosurgery, infrared photocoagulation, laser surgery) need not be applied until the acute process resolves except in cases of significant bleeding, intractable pain, recurrent episodes, and various individualized considerations. See: hemorrhoidectomy

Hemorrhoid located at or distal to the pectinate line (dentate margin), covered by anodermal epithelium or skin and extremely sensitive to most stimuli.

Hemorrhoid located proximal to the pectinate line, covered by mucous membrane and relatively insensitive to direct noxious stimuli.

Hemorrhoid that incorporates both internal and external components.

The protrusion of an internal hemorrhoid through the anus.

A prolapsed hemorrhoid that is trapped by the anal sphincter, thus compromising blood flow to the vein in the hemorrhoid.