Hemorrhoid facts Internal and external Hemorrhoid

Internal

Internal hemorrhoids are those that originate above the dentate line.^[7] They are covered by columnar epithelium which lacks pain receptors.^[4] They were classified in 1985 into four grades based on the degree of prolapse.^[4]^[3]

Grade I: No prolapse. Just prominent blood vessels.

Grade II: Prolapse upon bearing down but spontaneously reduce.

Grade III: Prolapse upon bearing down and requires manual reduction.

Grade IV: Prolapsed and cannot be manually reduced.

External

A thrombosed external hemorrhoid

External hemorrhoids are those that occur below the dentate or pectinate line.^[7] They are covered proximately by anoderm and distally by skin, both of which are sensitive to pain and temperature.^[4]

Formation of hemorrhoids

If the hemorrhoid originates at the top (rectal side) of the anal canal, it is referred to as an internal hemorrhoid. If it originates at the lower end of the anal canal near the anus, it is referred to as an external hemorrhoid. Technically, the differentiation between internal and external hemorrhoids is made on the basis of whether the hemorrhoid originates above or below the dentate line (internal and external, respectively).

As discussed previously, hemorrhoidal cushions in the upper anal canal are made up of blood vessels and their supporting tissues. There usually are three major hemorrhoidal cushions oriented right posterior, right anterior, and left lateral. During the formation of enlarged internal hemorrhoids, the vessels of the anal cushions swell and the supporting tissues increase in size. The bulging mass of tissue and blood vessels protrudes into the anal canal where it can cause problems. Unlike with internal hemorrhoids, it is not clear how external hemorrhoids form.

Prevention

A number of preventative measures are recommended including avoiding straining while attempting to defecate, avoiding constipation and diarrhea either by eating a high fiber diet and drinking plenty of fluid or taking fiber supplements, and getting sufficient exercise. Spending less time attempting to defecate, avoiding reading while on the toilet, as well as losing weight for overweight persons and avoiding heavy lifting are also recommended

Prevalence of hemorrhoids

Although hemorrhoids occur in everyone, they become large and cause problems in only 4% of the general population. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.

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Hemorrhoid facts

Internal hemorrhoids are clumps of tissue within the anal canal that contain blood vessels, muscle, and elastic fibers. External hemorrhoids are enlarged blood vessels surrounding the anus.
Internal hemorrhoids cause problems when they enlarge. The cause of the enlargement is not known.
Complications of internal hemorrhoids include bleeding, anal itchiness, prolapse, incarceration, and gangrene. Pain is not common.
The primary complication of external hemorrhoids is pain due to blood clotting in the hemorrhoidal blood vessels.
When dealing with hemorrhoids, it is important to exclude other diseases of the anus and rectum that may cause similar symptoms such as polyps, cancer, and diseases of the skin.
Treatment of hemorrhoids includes over-the-counter topical medications, sclerotherapy, rubber band ligation, heat coagulation,cryotherapy, anal dilation, Doppler ligation, sphincterotomy, and surgical hemorrhoidectomy. stapled hemorrhoidectomy.
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Hemorrhoid Treatments

Home Remedies and OTC Medication Treatments for Hemorrhoids

Over-the-counter products

Many over-the-counter products are sold for the treatment of hemorrhoids. Products used for the treatment of hemorrhoids are available as ointments, creams, gels, suppositories, foams, and pads.

Local anesthetics: Local anesthetics temporarily relieve pain, burning, and itching by numbing the nerve endings.
Vasoconstrictors:Vasoconstrictors are chemicals that resemble epinephrine, a naturally occurring chemical.
Protectants: Protectants prevent irritation of the perianal area by forming a physical barrier on the skin that prevents contact of the irritated skin with aggravating liquid or stool from the rectum.
Astringents: Astringents cause coagulation (clumping) of proteins in the cells of the perianal skin or the lining of the anal canal.
Antiseptics: Antiseptics inhibit the growth of bacteria and other organisms.
Keratolytics: Keratolytics are chemicals that cause the outer layers of skin or other tissues to disintegrate.
Analgesics: Analgesic products, like anesthetic products, relieve pain, itching, and burning by depressing receptors on pain nerves.
Corticosteroids:Corticosteroids reduce inflammation and can relieve itching, but their chronic use can cause permanent damage to the skin.
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Piles (haemorrhoids) - Treatment

Diagnosis

Internal hemorrhoid grades
Grade	Diagram	Picture
1
2
3
4

Hemorrhoids are typically diagnosed by physical examination.^[11] A visual examination of the anus and surrounding area may diagnose external or prolapsed hemorrhoids.^[2] A rectal exam may be performed to detect possible rectaltumors, polyps, an enlarged prostate, or abscesses.^[2] This examination may not be possible without appropriatesedation due to pain, although most internal hemorrhoids are not associated with pain.^[3] Visual confirmation of internal hemorrhoids may require anoscopy, a hollow tube device with a light attached at one end.^[5] There are two types of hemorrhoids: external and internal. These are differentiated by their position with respect to the dentate line. Some persons may concurrently have symptomatic versions of both. If pain is present the condition is more likely to be ananal fissure or an external hemorrhoid rather than an internal hemorrhoid.^[5]

The veins around your anus tend to stretch under pressure and may bulge or swell. Swollen veins — hemorrhoids — can develop from an increase in pressure in the lower rectum. Factors that might cause increased pressure include:

Straining during bowel movements
Sitting for long periods of time on the toilet
Chronic diarrhea or constipation
Obesity
Pregnancy
Anal intercourse

It's also possible to inherit a tendency to develop hemorrhoids. Hemorrhoids are more likely as you get older because the tissues that support the veins in your rectum and anus can weaken and stretch with aging.

The exact cause of symptomatic hemorrhoids is unknown.^[9] A number of factors are believed to play a role including: irregular bowel habits (constipation or diarrhea), a lack of exercise, nutritional factors (low-fiber diets), increased intra-abdominal pressure (prolonged straining, ascitis, an intra-abdominal mass, or pregnancy), genetics, an absence of valves within the hemorrhoidal veins, and aging.^[3]^[5] Other factors that are believed to increase the risk include obesity, prolonged sitting,^[2] a chronic cough and pelvic floor dysfunction.^[4] Evidence for these associations, however, is poor.^[4]

During pregnancy, pressure from the fetus on the abdomen and hormonal changes cause the hemorrhoidal vessels to enlarge. Delivery also leads to increased intra-abdominal pressures.^[10] Pregnant women rarely need surgical treatment, as symptoms usually resolve after delivery.