II. Definition

  1. Dilation of anorectal vessels

III. Epidemiology

  1. Most common anorectal condition
  2. Affects 50% of patients over age 50 years

IV. Anatomy

  1. See Rectal Anatomy
  2. Positions for internal and External Hemorrhoids
    1. Right Anterior
    2. Right Posterior
    3. Left Lateral

V. Pathophysiology

  1. Submucosal vessels dilate
  2. Connective tissue supporting vessels weakens and allows Hemorrhoid descent and prolapse

VI. Types

  1. Internal Hemorrhoids (above Dentate Line, share visceral innervation and painless)
  2. External Hemorrhoids (below Dentate Line, potentially painful)

VII. Causes

  1. Prolonged erect Posture
  2. Back flow
    1. Abdominal pressure
    2. Constipation and straining at Defecation
  3. Pregnancy
    1. Expect resolution after delivery
    2. Surgical intervention is both contraindicated and unnecessary
  4. Diarrhea (Relative Risk 2.1)
  5. Obesity (Relative Risk 1.7)
  6. Family History
  7. Portal Hypertension and Ascites
  8. Anatomic abnormalities
    1. No Hemorrhoidal venous valves
    2. Intrinsic weakness of anal blood vessels

VIII. Symptoms

  1. Pruritus Ani
  2. Rectal bleeding
  3. Rectal Pain (External Hemorrhoid)
  4. Prolapsed Hemorrhoid
  5. Fullness or mass sensation

IX. Signs

  1. Visual inspection
  2. Digital Rectal Exam
  3. Anoscopy (Ives Slotted Anoscope)
    1. Required to diagnose Internal Hemorrhoids (not discernable by Digital Rectal Exam)
    2. Internal Hemorrhoids will appear as dilated purple veins

X. Differential Diagnosis

XI. Diagnostics: Colonoscopy indications

  1. See Colorectal Cancer Screening for guidelines irrespective of Hemorrhoids
  2. Suspected Inflammatory Bowel Disease
  3. Consider in age over 40 years and signs of rectal bleeding
    1. Positive Fecal Occult Blood Test
    2. Iron Deficiency Anemia

XIII. References

  1. Pickard in Dornbrand (1992) Ambulatory Care, p. 225-6
  2. Schrock in Feldman (1998) Sleisenger GI, p. 1964-7
  3. Hulme-Moir (2001) Gastroenterol Clin North Am 30:183-97 [PubMed]
  4. Hussain (1999) Prim Care 26(1):35-51 [PubMed]

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Ontology: Hemorrhoids (C0019112)

Definition (MEDLINEPLUS)

Hemorrhoids are swollen, inflamed veins around the anus or lower rectum. They are either inside the anus or under the skin around the anus. They often result from straining to have a bowel movement. Other factors include pregnancy, aging and chronic constipation or diarrhea.

Hemorrhoids are very common in both men and women. About half of all people have hemorrhoids by age 50. The most common symptom of hemorrhoids inside the anus is bright red blood covering the stool, on toilet paper or in the toilet bowl. Symptoms usually go away within a few days.

If you have rectal bleeding you should see a doctor. You need to make sure bleeding is not from a more serious condition such as colorectal or anal cancer. Treatment may include warm baths and a cream or other medicine. If you have large hemorrhoids, you may need surgery and other treatments.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Definition (MSHCZE) Hemoroidy – řitní žilní městky, „zlatá žíla“. Rozšíření žilních struktur, které jsou v okolí dolní části konečníku a řitního kanálu. Na jejich vzniku se podílejí značnou měrou poruchy vyprazdňování, zejm. dlouhodobá zácpa. Vnitřní h. se projevují krvácením a v pozdější době mohou vyhřezávat do řitního kanálu. V léčbě je důležitá péče o stolici, úprava stravy, místní léčba (koupele, masti, čípky), někdy lze použít sklerotizace (njekčního podání látky, která vede k jejich uzávěru a zjizvení), v těžších případech se operují. Zevní h., které jsou viditelné pouhým okem, mohou někdy způsobit velmi bolestivý zánět. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI_CTCAE) A disorder characterized by the presence of dilated veins in the rectum and surrounding area.
Definition (NCI) Dilated veins in the anal canal.(NICHD)
Definition (NCI_NCI-GLOSS) An enlarged or swollen blood vessel, usually located near the anus or the rectum.
Definition (MSH) Swollen veins in the lower part of the RECTUM or ANUS. Hemorrhoids can be inside the anus (internal), under the skin around the anus (external), or protruding from inside to outside of the anus. People with hemorrhoids may or may not exhibit symptoms which include bleeding, itching, and pain.
Concepts Acquired Abnormality (T020)
MSH D006484
ICD9 455
ICD10 I84 , K64
SnomedCT 155477004, 195472000, 155469003, 70153002
HL7 HEM
LNC LP30519-0, MTHU015043
English HAEMORRHOIDS, HEMORRHOIDS, Haemorrhoids NOS, Hemorrhoids, hemorrhoids (diagnosis), hemorrhoids, Hemorrhoids [Disease/Finding], hemorrhoid (pile), haemorrhoid, pile, Hemorrhoids NOS (disorder), Haemorrhoid (disorder), Haemorrhoids NOS (disorder), hemorrhoid, Piles, Hemorrhoid, Haemorrhoid, Haemorrhoids, Piles - haemorrhoids, Piles - hemorrhoids, Hemorrhoids (disorder), Haemorrhoids, NOS, Hemorrhoids, NOS, Piles, NOS, Hemorrhoids NOS, piles, haemorrhoids
Portuguese HEMORROIDAS, Hemorroidas, Hemorróidas
Spanish HEMORROIDES, Almorranas, hemorroides, SAI (trastorno), Hemorrhoids NOS, Haemorrhoids NOS, hemorroides, SAI, hemorroides (trastorno), hemorroides, Hemorroides
German HAEMORRHOIDEN, Haemorrhoiden, Hämorrhoiden
Dutch aambeien, Hemorroàden, hemorroïden, Hemorroïden, Aambei, Aambeien, Hemorroïd
Japanese 痔核, ジカク
Swedish Hemorrojder
Czech hemoroidy, Hemoroidy, zlatá žíla
Finnish Peräpukamat
Russian GEMORROI, ГЕМОРРОЙ
French HEMORROIDES, Hémorroïdes
Korean 치질
Polish Hemoroidy, Żylaki odbytu, Guzki krwawnicze
Hungarian Haemorrhoidok, Aranyerek, Aranyeres csomók
Norwegian Hemoroider
Italian Emorroidi