Hemorrhoids

Hemorrhoids:  a varicose dilatation of a vein of the superior or inferior hemorrhoidal plexus.  Dilation and enlargement of the superior plexus produces internal hemorrhoids; dilation and enlargement of the inferior plexus produces external hemorrhoids, which may protrude from the rectum.

Cause:  Hemorrhoids probably result from increased intravenous pressure in the hemorrhoidal venous plexus.  Some of the risk factors may include occupations that require prolonged standing or sitting, straining due to constipation, diarrhea, coughing, sneezing, or vomiting; heart failure, hepatic disease, alcoholism, and anorectal infections; loss of muscle tone due to old age, rectal surgery, or episiotomy; anal intercourse, and pregnancy.

Symptoms:

Patient may be asymptomatic

Patient may have painless, intermittent bleeding during defecation.

Pruritus

Patient may have discomfort and prolapse in response to an increase in intra abdominal pressure

Sudden rectal pain

May have a large, firm, subcutaneous lump with thrombosed external hemorrhoids.

Treatment:

Typically, treatment aims to ease pain, combat swelling and congestion, and regulate bowel habits.
Local swelling and pain can be decreased with local anesthetic agents, astringents, or cold compresses, followed by warm sitz baths or thermal packs. (Rarely, the patient with chronic, profuse bleeding may require a blood transfusion)

The doctor may prescribed nonsurgical treatments that includes injection of a sclerosing solution to produce scar tissue that decreases prolapse; manual reduction; and hemorrhoid ligation or freezing.

For severe bleeding:  hemorrhoidectom is the most effective treatment.

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