Hemorrhoids




© Springer International Publishing Switzerland 2017
Bobby Desai and Alpa Desai (eds.)Primary Care for Emergency Physicians10.1007/978-3-319-44360-7_19


19. Hemorrhoids



Run Gan 


(1)
Family Medicine, UF Health, Gainesville, FL 32669, USA

 



 

Run Gan



Keywords
HemorrhoidsInternal and external hemorrhoidsProlapse



19.1 Introduction


Hemorrhoids are a common cause of anal bleeding, itching, and pain. It is estimated that 4.4 % of the population has symptomatic hemorrhoids while the true prevalence of asymptomatic hemorrhoids is unknown [4]. Males and females are affected equally and peak around age 45–65 years old. Hemorrhoids are uncommon before age 20.

Hemorrhoids result from dilation of the veins around the anus and rectum. Internal hemorrhoids originate above the dentate line [1]. They are covered by columnar epithelium, which lacks pain receptors. They were classified into four grades based on the degree of prolapse [2].



  • Grade I: No prolapse, just prominent blood vessels


  • Grade II: Prolapse upon bearing down, but spontaneous reduction


  • Grade III: Prolapse upon bearing down requiring manual reduction


  • Grade IV: Prolapse with inability to be manually reduced

External hemorrhoids occur below the dentate. They have somatic innervations and thus are sensitive to pain and temperature [2].


19.2 Risk Factors for Hemorrhoids






  • Prolonged straining


  • Constipation


  • Diarrhea


  • Pregnancy


  • Ascites


  • Heavy lifting


19.3 Differential Diagnosis




Nov 20, 2017 | Posted by in Uncategorized | Comments Off on Hemorrhoids

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