Skip to main content
General Medicine

Hemorrhoids

Donna I. Meltzer, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Varicosities of the hemorrhoidal venous plexus

  • External hemorrhoids

    • Located below the dentate line; visceral innervation (painful)

    • Covered by squamous epithelium

  • Internal hemorrhoids

    • Loca...

DIAGNOSIS

Diagnosis is typically straightforward through history and inspection of the perineum, rectal exam, and anoscopy. 

HISTORY

  • Symptoms (1)

    • Bleeding (~60%)

    • Classically, bright red blood per rectum, ...

TREATMENT

Prevention 

  • Fiber supplements

  • Stool softeners

  • Anal hygiene

GENERAL MEASURES

  • Hemorrhoids are a recurrent disease, even after surgical excision. Preventive measures should be continued indefinitely...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Encourage physical fitness, weight management, and dietary compliance.

  • Avoid prolonged sitting and straining on the toilet.

Patient Monitoring

As needed, depending o...

REFERENCES

1
Jacobs D. Clinical practice. Hemorrhoids. N Engl J Med.  2014;371(10):944–951. [View Abstract on OvidMedline]
2
Mott T, Latimer K, Edwards C. Hemorrhoids: diagnosis and treatment option...

ADDITIONAL READING

  • Brown SR, Watson A. Comments to “rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids.” Tech Coloproctol.  2016;20(9):659–661. [View Abstract on OvidMedlin...

CODES

ICD10

  • K64.9 Unspecified hemorrhoids

  • K64.0 First degree hemorrhoids

  • K64.1 Second degree hemorrhoids

  • K64.2 Third degree hemorrhoids

  • K64.4 Residual hemorrhoidal skin tags

  • K64.8 Other hemorrhoids

  • K64.3 Fou...

CLINICAL PEARLS

  • Hemorrhoids are very common. Internal hemorrhoids are typically painless. External hemorrhoids are typically painful.

  • All patients should be encouraged to consume 25 to 35 g of fiber pe...

Subscribe to Access Full Content

Sign Up for a 10-Day Free Trial

Sign up for a 10-day FREE Trial now and receive full access to all content.

START 10-DAY FREE TRIAL
Subscribe Now
GET CME/CE
Related Images
Left Arrow Button Right Arrow Button
(1) Anatomy of the anal canal showing the location of internal and external hemorrhoids.
(1) Anatomy of the anal canal showing the location of internal and external hemorrhoids.
Figure 15-18 Internal and external hemorrhoids. Hemorrhoids bleed regularly, leaving bright red blood on the stool surface.
Figure 15-18 Internal and external hemorrhoids. Hemorrhoids bleed regularly, leaving bright red blood on the stool surface.
Adenocarcinoma of the colon. The opened colon contains an elevated, centrally ulcerated, infiltrating mass.
Adenocarcinoma of the colon. The opened colon contains an elevated, centrally ulcerated, infiltrating mass.
Adenocarcinoma of the colon with intestinal obstruction. The lumen of the colon at the site of the cancer is narrow. The colon above the obstruction is dilated.
Adenocarcinoma of the colon with intestinal obstruction. The lumen of the colon at the site of the cancer is narrow. The colon above the ob...
Figure 56-4 External hemorrhoid in a 2-year-old male with recurrent straining because of chronic constipation.
Figure 56-4 External hemorrhoid in a 2-year-old male with recurrent straining because of chronic constipation.
Tubular adenoma of the colon. A pedunculated tubular adenoma.
Tubular adenoma of the colon. A pedunculated tubular adenoma.
Tubular adenoma of the colon. A low-power photomicrograph of a tubular adenoma of the colon shows closely packed epithelial tubules. The fibrous stalk is vascular and covered by normal colonic epithelium.
Tubular adenoma of the colon. A low-power photomicrograph of a tubular adenoma of the colon shows closely packed epithelial tubules. The fi...
    ×
     
    ©2019 Wolters Kluwer Health, Inc. and/or its affiliates. All rights reserved.

    Enter An Access Code

     
    We are unable to redeem your access code. Please try again another time.
    Enter the code from your copy of The 5-Minute Clinical Consult or another access code to create an account.
    ×
    ×
    This site uses cookies. By continuing to use our website, you are agreeing to our privacy policy. | Accept