-IBIS-1.5.0-
tx
digestive system
hemorrhoids
diagnoses

definition and etiology

definition:
varicosities of the internal and/or external hemorrhoidal plexuses

etiology:
Hemorrhoids occur in the right anterior, right posterior, and left posterolateral positions. Internal hemorrhoids are found just above the anal canal, while external hemorrhoids are located beneath the anoderm of external skin. If a patient presents with external hemorrhoids, there is a good probability that he/she also has internal hemorrhoids. The hemorrhoidal plexuses drain into the valveless portal venous circulation so factors that increase the hydrostatic pressure of the portal veins can initiate the development of hemorrhoids. These factors include:
• heredity
• pregnancy
• sedentary lifestyle
• straining at stool: chronic constipation
• standing for long periods of time
• sitting on hard, cold surfaces
• liver stagnancy or disease (cirrhosis)
• benign prostatic hypertrophy
• anal intercourse

signs and symptoms

signs and symptoms:
• bright red blood on the toilet paper or in the toilet bowl
• prolapse may occur, but usually reduces spontaneously; may be associated with edema and spasm of the sphincter; may become chronic and need manual reduction
• pain: seen only with external hemorrhoids, particularly if they suddenly increase in size
• mucus discharge may be associated with itching

lab findings:
• visual exam will detect the external hemorrhoids
• anoscopy will detect the internal hemorrhoids
• proctoscopy or barium enema might be done to rule out other pathology
• Hgb and Hct to check for anemia

course and prognosis

Recurrences are common unless the predisposing conditions are altered. External hemorrhoids tend to regress when internal hemorrhoids are treated. Internal hemorrhoids may be treated with stool softeners, sitz baths, increased fluid intake etc. The most effective treatments presently available are galvanic (Keesey treatment) and infrared cauterization. Both are non-surgical outpatient procedures with high success rates and few complications.

Severe thrombosed external hemorrhoids may require surgical incision and clot removal.

differential diagnosis

• other gastrointestinal or proctologic conditions causing pain and/or bleeding, e.g. tumor, hematoma, anal fissure etc.


footnotes