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Causes and Incidence The exact causal mechanism for hemorrhoid formation is unknown but is hypothesized to be associated with increased pressure, which causes congestion in the hemorrhoidal plexus in the anus. Increased pressure has been attributed to straining on defecation, various occupations that require prolonged standing or sitting, pregnancy, and chronic constipation. Hemorrhoids occur universally in children and adults and are treated as a normal finding when asymptomatic. Symptoms such as pain, bleeding, and protrusion are most often seen in adults between 20 and 50 years of age.

Disease Process A hemorrhoid is formed when a portion of the vascular mound of the hemorrhoidal plexus weakens and prolapses after being subjected to increased vascular pressures over time. These projections from the anal lining are subject to ulceration and infection.

Symptoms Typical symptoms include pain and bright red blood on toilet tissue following defecation. A rectal skin tag may be present. Strangulation of a hemorrhoid may produce severe pain. Mucus production is sometimes seen.

Potential Complications The most common complication is strangulation of an ulcerated and edematous hemorrhoid. In rare cases, severe bleeding may occur and lead to secondary anemia.

Diagnostic Tests Hemorrhoids are easily diagnosed by direct rectal examination or anoscopy.

Treatments

Surgery

Injection sclerotherapy to eliminate bleeding hemorrhoids; rubber band ligation for protruding, nonreducible internal hemorrhoids

Drugs

Topical anesthetic ointments for pain; stool softeners; analgesics

General

High-fiber diet; adequate hydration; warm sitz baths; use of wet wipes instead of toilet paper