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Hemorrhoid, Emergency Medicine

Julia H. Sone Reviewed 06/2017



  • General:

    • Normal venous sinusoids of the distal rectum and proximal anal canal

    • Normal vascular cushions of anal canal that contribute to anal continence

    • Arteriovenous shunt system exists...


Signs and Symptoms

  • Painless, rectal bleeding with defecation

  • Blood on stool or toilet paper

  • Bright red blood drips into toilet bowel

  • Rectal discomfort or pressure

  • Severe pain if:

    • Internal hemorrho...



Establish IV access if severe bleeding 

Initial Stabilization/Therapy

Direct digital pressure to control bleeding 

Ed Treatment/Procedures

  • Conservative therapy for all patients:

    • Hot s...



Admission Criteria

  • Strangulated grade 4 hemorrhoids:

    • Surgical consult for prolapsed, thrombosed internal hemorrhoids

  • Severe anemia with bleeding hemorrhoids

  • Severe bleeding hemorrhoid...

Pearls and Pitfalls

Hemorrhoids are not the only cause of anorectal pain and bleeding. Investigate for other etiologies when indicated. 

Additional Reading

  • Acheson  AG, Scholefield  JH. Management of hemorrhoids. BMJ.  2008;336(7640):380–383.

  • Kaider-Person  O, Person  B, Wexner  SD. Hemorrhoidal disease. J Am Coll Surg.  2007;...



  • 455.0 Internal hemorrhoids without mention of complication

  • 455.3 External hemorrhoids without mention of complication

  • 455.6 Unspecified hemorrhoids without mention of complication

  • 455.2 Interna...

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