Updated: 4/21/2019

Hemorrhoids

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Snap Shot
  •  A 54-year-old male with a history of alcohol abuse presents with complaints of a mass in his anus.
Introduction
  • Engorgement of venous plexus derived from
    • superior hemorrhoid vein (internal hemorrhoids)
    • inferior hemorrhoid vein (external hemorrhoids)
  • Risk factors
    • pregnancy
    • straining at stool
      • often secondary to low fiber diet
    • obesity
    • anal intercourse
    • cirrhosis with portal hypertension
Presentation
  • Symptoms
    • internal hemorrhoids
      • non-painful
      • anal mass / prolapse
      • bleeding / blood in stool
      • pruritis
    • external hemorrhoids
      • pain
      • pruritis
      • bleeding (can present without bleeding)
  • Physical exam
    • internal hemorrhoids
      • above the dentate line
    • external hemorrhoids
      • below dentate line
Treatment
  • Lifestyle modifications
    • proper dietary (fiber) and bowel habits
    • warm soaks
    • avoidance of prolonged periods of sitting
  • Medical
    • stool softeners
    • cortisone cream
  • Surgical
    • banding
    • sclerotherapy
    • laser surgery
    • hemorrhoidectomy 
      • for large refractory hemorrhoids
      • most painful but best result
 

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