- Varicosities of the hemorrhoidal venous plexus
- External hemorrhoids are located below the dentate line and covered by squamous epithelium.
- Internal hemorrhoids are located above the dentate line.
- Both types of hemorrhoids often coexist.
- Classification of internal hemorrhoids:
- First degree: Hemorrhoids do not prolapse.
- Second degree: Prolapse through the anus on straining but reduce spontaneously
- Third degree: Protrude and require digital reduction
- Fourth degree: Cannot be reduced
- Hemorrhoids often progress from itching, bleeding stage to protrusion with easy reduction, then difficult reduction, and finally rectal prolapse. Thrombosis may occur at any protrusion stage.
Common in elderly along with rectal prolapsePediatric Considerations
- Uncommon in infants and children. Look for underlying cause (e.g., venacaval or mesenteric obstruction, cirrhosis, portal HTN).
- Occasionally, as in adults, hemorrhoids may result from chronic constipation, fecal impaction, and straining at stool. Surgery is rarely required in children.
- Common in pregnancy
- Usually resolves after pregnancy
- No treatment required, unless extremely painful
Hemorrhoids has been found in 5-Minute Clinical Consult
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