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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...

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Related Images
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(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.
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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.
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