Hemorrhoids are swollen blood vessels in the anus and lower rectum that become engorged due to increased pressure, similar to what occurs in varicose veins in the legs.
Anatomy
The rectum is the last few inches of the colon. It is the part of the colon after the sigmoid colon. It’s connected to the anal canal, which leads stool out of the body through an opening known as the anus.
The anal canal is about 4 cm long. Hemorrhoids can occur above or below an anatomical line inside of the anal canal called the dentate line.
Hemorrhoids found above the dentate line (in the lower rectum) are known as internal hemorrhoids.
Hemorrhoids found below the dentate line (closer to the external environment) are called external hemorrhoids.
Both types of hemorrhoids are graded on a scale of 1-4 based on the extent of prolapse or bulging.
Grade I hemorrhoids bleed but don’t prolapse.
Grade II hemorrhoids prolapse outside the anal canal but reduce spontaneously.
Grade III hemorrhoids prolapse outside the anal canal and require manual reduction.
Grade IV hemorrhoids are constantly prolapsed.
What causes hemorrhoids?
Pressure
Repeated straining with bowel movements
Heavy lifting
Prolonged sitting or standing
Obesity, particularly central obesity
Pregnancy
Cirrhosis of the liver with ascites
Constipation
Diarrhea
A low-fiber diet
Pelvic floor dysfunction
What are the symptoms of hemorrhoids?
Pain
Itching
Burning
Throbbing
A bulge felt around the anus
Rectal bleeding or blood noticed on toilet paper with wiping
How are Hemorrhoids diagnosed?
Hemorrhoids are suspected with the above-mentioned symptoms.
External hemorrhoids may be seen on exam of the anus, or felt during a digital rectal exam.
Anoscopy is used to evaluate or internal hemorrhoids. This is a minor procedure performed in the office where a small plastic speculum is inserted into your anus to visualize the area. It takes just a few minutes and is typically performed without anesthesia.
Flexible sigmoidoscopy and colonoscopy are other options that allow us to evaluate for suspected hemorrhoids.