Hemorrhoids Disease

BASICS

DESCRIPTION

Varicosities of the hemorrhoidal venous plexus. Usual course - acute; chronic; relapsing.

External hemorrhoids are located below the dentate line and covered by squamous epithelium
Internal hemorrhoids are located above the dentate line
System(s) affected: Gastrointestinal, Cardiovascular
Genetics: No known genetic pattern
Incidence/Prevalence in USA: Common
Predominant age: Adults, although may occur at any age
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

All cases:
- Constipation
- Straining with defecation
Small or minimal:
- Episodic bleeding on stool
Extensive internal:
- Feeling of incomplete evacuation
Small or minimal external:
- Pruritus
Protruding but reducible:
- Mass
- Prominent bleeding
- Pruritus
- Thrombosis with severe acute pain
Protruding, not reducible:
- Mass
- Inability to clean after stool
- Thrombosis common
- Strangulation possible
- Ulceration

CAUSES

Dilated veins of hemorrhoidal plexus
Tight internal anal sphincter

RISK FACTORS

Pregnancy
Colon malignancy
Liver disease
Portal hypertension
Constipation
Occupations that require prolonged sitting
Loss of muscle tone in old age, rectal surgery, episiotomy, anal intercourse
Obesity

DIAGNOSIS

LABORATORY

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Anorectal examination including anoscopy
Sigmoidoscopy
Inspection following straining at stool

TREATMENT

APPROPRIATE HEALTH CARE

All of these treatments, except surgical, are outpatient with recovery and freedom from symptoms within 48 hours

GENERAL MEASURES

Mild symptoms or prevention:
- Avoid prolonged sitting at stool
- Avoid straining
- Prevent constipation with stool softeners and high-fiber diet or supplements
- Use soap and water for cleanup after stool
For pain: sitz baths with soapy water or hypertonic Epsom salts (1 cup per 2 quarts of water)
Mild and minimal hemorrhoids respond to dietary changes, relief of constipation, soap and water cleanup, and brief stooling
Pruritus or mild discomfort after stooling responds to hydrocortisone ointment, anesthetic ointments or sprays
Mild bleeding with external hemorrhoids responds to sitz baths and ointments or suppositories

SURGICAL MEASURES

Indications for intervention:
- Persisting and soiling bleeding
- Prolapsed internal hemorrhoids
- Poor anal hygiene due to prolapsed hemorrhoids
- Persistent pain
Treatments:
- Severe pain:
  - Incision of thrombosed hemorrhoid
- Severe protruding hemorrhoids:
  - Rubber band ligation (internal hemorrhoids only)
  - Injection therapy (suitable for one or two hemorrhoids)
  - Cryosurgery, infrared, or laser surgery for external hemorrhoids
- Prolapsed rectum:
  - Requires surgical correction
- Surgical resection:
  - For major external or internal hemorrhoids

ACTIVITY

No restrictions
Encourage physical fitness
Avoid prolonged sitting and straining on the toilet

DIET

High fiber

PATIENT EDUCATION

Explain recurrence benignity, need for good diet, exercise and stooling health

FOLLOW UP

PREVENTION/AVOIDANCE

Avoid constipation
Lose weight, if overweight
Avoid prolonged sitting on the toilet
Avoid prolonged sitting at work; get up and move around periodically

POSSIBLE COMPLICATIONS

Thrombosis
Secondary infection
Ulceration
Anemia (rare)
Incontinence

EXPECTED COURSE AND PROGNOSIS

Spontaneous resolution
Recurrence

MISCELLANEOUS

ASSOCIATED CONDITIONS

Liver disease
Pregnancy
Portal hypertension
Constipation

AGE-RELATED FACTORS

Pediatric:

Uncommon in infants and children. Look for underlying cause, e.g., venacaval or mesenteric obstruction, cirrhosis, portal hypertension.
Occasionally, as in adults, hemorrhoids may result from chronic constipation, fecal impaction, and straining at stool. Surgery is rarely required.

Geriatric: Common in elderly along with rectal prolapse
Others: N/A

PREGNANCY

Common in pregnancy. Usually resolves after pregnancy. No treatment required, unless extremely painful.

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.