Hemorrhoid

"Piles" redirects here. For other uses, see Piles (disambiguation).

Hemorrhoids
Other namesHaemorrhoids, piles,[1] hemorrhoidal disease[2]
Diagram demonstrating the anatomy of both internal and external hemorrhoids
Pronunciation
  • UK: /ˈhɛmərɔɪdz/
SpecialtyGeneral surgery
SymptomsInternal: Painless, bright red rectal bleeding[3]
External: Pain and swelling around the anus[4]
Usual onset45–65 years of age[5]
DurationFew days[3]
CausesUnknown[4]
Risk factorsConstipation, diarrhea, sitting on the toilet for long periods, pregnancy[3]
Diagnostic methodExamination, rule out serious causes[2][3]
TreatmentIncreased fiber, drinking fluids, NSAIDs, rest, surgery, hemorrhoidal artery embolization[1][6]
Frequency50–66% at some time[1][3]

Hemorrhoids (or haemorrhoids), also known as piles, are vascular structures in the anal canal.[7][8] In their normal state, they are cushions that help with stool control.[2] They become a disease when swollen or inflamed; the unqualified term hemorrhoid is often used to refer to the disease.[8] The signs and symptoms of hemorrhoids depend on the type present.[4] Internal hemorrhoids often result in painless, bright red rectal bleeding when defecating.[3][4] External hemorrhoids often result in pain and swelling in the area of the anus.[4] If bleeding occurs, it is usually darker.[4] Symptoms frequently get better after a few days.[3] A skin tag may remain after the healing of an external hemorrhoid.[4]

While the exact cause of hemorrhoids remains unknown, a number of factors that increase pressure in the abdomen are believed to be involved.[4] This may include constipation, diarrhea, and sitting on the toilet for long periods.[3] Hemorrhoids are also more common during pregnancy.[3] Diagnosis is made by looking at the area.[3] Many people incorrectly refer to any symptom occurring around the anal area as hemorrhoids, and serious causes of the symptoms should not be ruled out.[2] Colonoscopy or sigmoidoscopy is reasonable to confirm the diagnosis and rule out more serious causes.[9]

Often, no specific treatment is needed.[9] Initial measures consist of increasing fiber intake, drinking fluids to maintain hydration, NSAIDs to help with pain, and rest.[1] Medicated creams may be applied to the area, but their effectiveness is poorly supported by evidence.[9] A number of minor procedures may be performed if symptoms are severe or do not improve with conservative management.[6] Hemorrhoidal artery embolization (HAE) is a safe and effective minimally invasive procedure that can be performed and is typically better tolerated than traditional therapies.[10][11][12] Surgery is reserved for those who fail to improve following these measures.[6]

Approximately 50% to 66% of people have problems with hemorrhoids at some point in their lives.[1][3] Males and females are both affected with about equal frequency.[1] Hemorrhoids affect people most often between 45 and 65 years of age,[5] and they are more common among the wealthy,[4] although this may reflect differences in healthcare access rather than true prevalence.[13] Outcomes are usually good.[3][9]

The first known mention of the disease is from a 1700 BC Egyptian papyrus.[14]

  1. ^ a b c d e f Lorenzo-Rivero, S (August 2009). "Hemorrhoids: diagnosis and current management". Am Surg. 75 (8): 635–42. doi:10.1177/000313480907500801. PMID 19725283. S2CID 220122385.
  2. ^ a b c d Beck, David E. (2011). The ASCRS textbook of colon and rectal surgery (2nd ed.). New York: Springer. p. 175. ISBN 978-1-4419-1581-8. Archived from the original on 2014-12-30.
  3. ^ a b c d e f g h i j k l "Hemorrhoids". National Institute of Diabetes and Digestive and Kidney Diseases. November 2013. Archived from the original on 26 January 2016. Retrieved 15 February 2016.
  4. ^ a b c d e f g h i Sun, Z; Migaly, J (March 2016). "Review of Hemorrhoid Disease: Presentation and Management". Clinics in Colon and Rectal Surgery. 29 (1): 22–29. doi:10.1055/s-0035-1568144. PMC 4755769. PMID 26929748.
  5. ^ a b Kaidar-Person, O; Person, B; Wexner, SD (January 2007). "Hemorrhoidal disease: A comprehensive review" (PDF). Journal of the American College of Surgeons. 204 (1): 102–17. doi:10.1016/j.jamcollsurg.2006.08.022. PMID 17189119. Archived from the original (PDF) on 2012-09-22.
  6. ^ a b c Rivadeneira, DE; Steele, SR; Ternent, C; Chalasani, S; Buie, WD; Rafferty, JL; Standards Practice Task Force of The American Society of Colon and Rectal Surgeons (September 2011). "Practice parameters for the management of hemorrhoids (revised 2010)". Diseases of the Colon and Rectum. 54 (9): 1059–64. doi:10.1097/DCR.0b013e318225513d. PMID 21825884. S2CID 29688768.
  7. ^ Chen, Herbert (2010). Illustrative Handbook of General Surgery. Berlin: Springer. p. 217. ISBN 978-1-84882-088-3.
  8. ^ a b Schubert, MC; Sridhar, S; Schade, RR; Wexner, SD (July 2009). "What every gastroenterologist needs to know about common anorectal disorders". World J Gastroenterol. 15 (26): 3201–09. doi:10.3748/wjg.15.3201. ISSN 1007-9327. PMC 2710774. PMID 19598294.
  9. ^ a b c d Hollingshead, JR; Phillips, RK (January 2016). "Haemorrhoids: modern diagnosis and treatment". Postgraduate Medical Journal. 92 (1083): 4–8. doi:10.1136/postgradmedj-2015-133328. PMID 26561592. S2CID 207022763.
  10. ^ Cite error: The named reference :0 was invoked but never defined (see the help page).
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  12. ^ Cite error: The named reference :3 was invoked but never defined (see the help page).
  13. ^ Cite error: The named reference p663 was invoked but never defined (see the help page).
  14. ^ Ellesmore, Windsor (2002). "Surgical History of Haemorrhoids". In Charles MV (ed.). Surgical Treatment of Haemorrhoids. London: Springer.