Hemorrhoid - Wikipedia

"Piles" redirects here. For other uses, see Piles (disambiguation).

Hemorrhoids (or haemorrhoids), also known as piles, are vascular structures in the anal canal.[7][8] In their normal state, they are cushions that help with stool control.[2] They become a disease when swollen or inflamed; the unqualified term hemorrhoid is often used to refer to the disease.[8] The signs and symptoms of hemorrhoids depend on the type present.[4] Internal hemorrhoids often result in painless, bright red rectal bleeding when defecating.[3][4] External hemorrhoids often result in pain and swelling in the area of the anus.[4] If bleeding occurs, it is usually darker.[4] Symptoms frequently get better after a few days.[3] A skin tag may remain after the healing of an external hemorrhoid.[4]

Hemorrhoids
Other names	Haemorrhoids, piles,[1] hemorrhoidal disease[2]
Diagram demonstrating the anatomy of both internal and external hemorrhoids
Pronunciation	UK: /ˈhɛmərɔɪdz/
Specialty	General surgery
Symptoms	Internal: Painless, bright red rectal bleeding[3]External: Pain and swelling around the anus[4]
Usual onset	45–65 years of age[5]
Duration	Few days[3]
Causes	Unknown[4]
Risk factors	Constipation, diarrhea, sitting on the toilet for long periods, pregnancy[3]
Diagnostic method	Examination, rule out serious causes[2][3]
Treatment	Increased fiber, drinking fluids, NSAIDs, rest, surgery, hemorrhoidal artery embolization[1][6]
Frequency	50–66% at some time[1][3]

While the exact cause of hemorrhoids remains unknown, a number of factors that increase pressure in the abdomen are believed to be involved.[4] This may include constipation, diarrhea, and sitting on the toilet for long periods.[3] Hemorrhoids are also more common during pregnancy.[3] Diagnosis is made by looking at the area.[3] Many people incorrectly refer to any symptom occurring around the anal area as hemorrhoids, and serious causes of the symptoms should be ruled out.[2] Colonoscopy or sigmoidoscopy is reasonable to confirm the diagnosis and rule out more serious causes.[9]

Often, no specific treatment is needed and hemorrhoids that do not cause symptoms do not require treatment.[9][10] Initial measures consist of increasing fiber intake, drinking fluids to maintain hydration, NSAIDs to help with pain, and rest.[1] Medicated creams may be applied to the area, but their effectiveness is poorly supported by evidence.[9] A number of minor procedures may be performed if symptoms are severe or do not improve with conservative management.[6] Hemorrhoidal artery embolization (HAE) is a safe and effective minimally invasive procedure that can be performed and is typically better tolerated than traditional therapies.[11][12][13] Surgery is reserved for those who fail to improve following these measures.[6]

Approximately 50% to 66% of people have problems with hemorrhoids at some point in their lives.[1][3] Males and females are both affected with about equal frequency.[1] Hemorrhoids affect people most often between 45 and 65 years of age,[5] and they are more common among the wealthy,[4] although this may reflect differences in healthcare access rather than true prevalence.[14] Outcomes are usually good.[3][9]

The first known mention of the disease is from a 1700 BC Egyptian papyrus.[15]

Contents

• 1 Signs and symptoms
  • 1.1 External
  • 1.2 Internal
• 2 Causes
• 3 Pathophysiology
• 4 Diagnosis
  • 4.1 Internal
  • 4.2 External
  • 4.3 Differential
• 5 Prevention
• 6 Management
  • 6.1 Conservative
  • 6.2 Procedures
  • 6.3 Surgery
• 7 Epidemiology
• 8 History
• 9 Notable cases
• 10 References
• 11 External links