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Hemorrhoids

Donna I. Meltzer, MD Reviewed 04/2024
 


BASICS

DESCRIPTION

  • Varicosities of the hemorrhoidal venous plexus

  • External hemorrhoids

    • Located below (distal to) the dentate line; somatic innervation (painful)

    • Covered by squamous epithelium

  • Internal hemo...

DIAGNOSIS

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

HISTORY

  • Symptoms

    • Bleeding (~60%)

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

TREATMENT

Prevention 
  • Fiber supplements and adequate fluid intake

  • Stool softeners

  • Anal hygiene

GENERAL MEASURES

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

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
Mott  T, Latimer  K, Edwards  C. Hemorrhoids: diagnosis and treatment options. Am Fam Physician.  2018;97(3):172–179. [View Abstract on OvidMedline] ...

ADDITIONAL READING

  • Ng KS, Holzgang M, Young C. Still a case of “no pain, no gain”? An updated and critical review of the pathogenesis, diagnosis, and management options for hemorrhoids in 2...

SEE ALSO

Colon Cancer; Portal Hypertension; Rectal Cancer 

CODES

ICD10

  • K64.9 Unspecified hemorrhoids

  • K64.4 Residual hemorrhoidal skin tags

  • K64.1 Second degree hemorrhoids

  • K64.3 Fourth degree hemorrhoids

  • K64.0 First degree hemorrhoids

  • K64.2 Third degree hemorrhoids

  • K...

CLINICAL PEARLS

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

  • Many cases can be managed conservatively

  • All patients should be encourage...

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