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HemorrhoidS
Classification and external resources
Schematic demonstrating the anatomy of hemorrhoids.
ICD-10 I84.
ICD-9 455
MedlinePlus 000292
eMedicine med/2821 

Hemorrhoids (AmE), haemorrhoids (BrE), emerods, or piles are varicosities or swelling and inflammation of veins in the rectum and anus. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings I00-I99 - Diseases of the Circulatory system (I00-I02 Acute rheumatic fever ( Rheumatic fever without mention of Heart The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Phonology North American English regional phonology In many ways compared to English English, North American English is conservative in its Phonology. British English or UK English ( BrE, BE, en-GB) is the broad term used to distinguish the forms of the English language used in the In medical parlance, swelling is the enlargement of organs caused by accumulation of excess fluid in tissues, called Edema. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens In the Circulatory system, a vein is a Blood vessel that carries Blood back toward the Heart (as opposed to Artery, a blood vessel The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth.

Hemorrhoids are actually the anatomical term for "'Cushions of tissue filled with blood vessels at the junction of the rectum and the anus. The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth. "[1] However, the term has come into common usage to indicate the condition described herein. Perianal hematoma are sometimes misdiagnosed and mislabeled as hemorrhoids, when in fact they have different causes and treatments. A Perianal hematoma is a type of Hematoma located in or on the border of the Anus. [2]

Contents

Prevalence

Hemorrhoids are common. In the USA, the prevalence is about 4. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given 4%. [3][4] It is estimated that approximately one half of all Americans have had this condition by the age of 50, and that 50% to 85% of the world's population will be affected by hemorrhoids at some time in their life. However, only a small number seek medical treatment. Annually, only about 500,000 in the U. S. are medically treated for massive hemorrhage, with 10 to 20% of them requiring surgeries.

According to a British medical journal of 1972 hemorrhoids "are common in economically developed communities, rare in developing countries, and almost unknown in tribal communities, where the influence of Western countries is slight. "[5]

Causes

Increased straining during bowel movements, by constipation or diarrhea, may lead to hemorrhoids. Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea [6] It is thus a common condition due to constipation caused by water retention in women experiencing premenstrual syndrome or menstruation. Premenstrual syndrome ( PMS) (sometimes referred to as PMT or Premenstrual Tension) is a collection of physical psychological and emotional symptoms See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry.

Hypertension, particularly portal hypertension, can also cause hemorrhoids because of the connections between the portal vein and the vena cava which occur in the rectal wall -- known as portocaval anastomoses. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated In Medicine, portal hypertension is Hypertension (high blood pressure in the Portal vein and its branches The superior and inferior vena cava are collectively called the venae cavae. A portacaval anastomosis (also known as portal systemic anastomosis) is a specific type of Anastomosis that occurs between the veins of Portal circulation [7]

Obesity can be a factor by increasing rectal vein pressure. Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected Sitting for prolonged periods of time can cause hemorrhoids. Poor muscle tone or poor posture can result in too much pressure on the rectal veins.

Pregnancy causes hypertension and increases strain during bowel movements, so hemorrhoids are often associated with pregnancy. Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female

Excessive consumption of alcohol or caffeine can cause hemorrhoids. In Chemistry, an alcohol is any Organic compound in which a Hydroxyl group ( - O[[hydrogen H]]) is bound to a Carbon Caffeine is a bitter white crystalline Xanthine Alkaloid that acts as a Psychoactive Stimulant Drug and a mild Diuretic [8] Both can cause diarrhea. Note that caffeine ingestion increases blood pressure transiently, but is not thought to cause chronic hypertension. Alcohol can also cause alcoholic liver disease leading to portal hypertension. Alcoholic liver disease is the major cause of Liver disease in Western countries (in Asian countries viral Hepatitis is the major cause In Medicine, portal hypertension is Hypertension (high blood pressure in the Portal vein and its branches

Symptoms

Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching, also called pruritus ani, have similar symptoms and are incorrectly referred to as hemorrhoids.

Hemorrhoids usually are not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days.

Although many people have hemorrhoids, not all experience symptoms. The most common symptom of internal hemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal hemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding hemorrhoid.

Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external hemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.

Food

Insufficient liquid can cause a hard stool, or even chronic constipation, which can lead to hemorrhoidal irritation. An excess of lactic acid in the stool, a product of excessive consumption of dairy products such as cheese, can cause irritation; reducing such consumption can bring relief. Lactic acid ( IUPAC Systematic name: 2-hydroxypropanoic acid) also known as milk acid, is a Chemical compound that plays a role Cheese is a Food made from Milk, usually the milk of cows, Buffalo, Goats or sheep, by coagulation. Vitamin E deficiency is also a common cause. See also Tocopherol, Tocotrienol Vitamin E is the collective name for a set of 8 related Tocopherols and Tocotrienols which are fat-soluble

Eating fruit helps avoid conditions that lead to hemorrhoids.

Food considered "probiotic", such as yogurt with active culture, may help keep the gut functioning normally and thus prevent flare-ups. Probiotics are Dietary supplements containing potentially beneficial Bacteria or Yeasts According to the currently adopted definition by FAO /

Types of hemorrhoids

Direct view of hemorrhoid seen on sigmoidoscopy
Direct view of hemorrhoid seen on sigmoidoscopy

By degree of prolapse

The most common grading system was developed by Banov:[3][10]

Prevention

Prevention of hemorrhoids includes drinking more fluids, eating more dietary fiber (such as fruits, vegetables and cereals high in fiber), exercising, practicing better posture, and reducing bowel movement strain and time. Dietary fibers are the indigestible portion of plant foods that move food through the Digestive system, absorbing water and easing Defecation. Defecation is the final act of Digestion by which organisms eliminate solid semisolid or liquid Waste material ( Faeces) from the Digestive tract Hemorrhoid sufferers should avoid using laxatives and should strictly limit time straining during bowel movement. Laxatives (or purgatives) are foods compounds or drugs taken to induce bowel movements or to loosen the stool most often taken to treat Constipation. Wearing tight clothing and underwear will also contribute to irritation and poor muscle tone in the region and promote hemorrhoid development. Some sufferers report a more comfortable experience without underwear or wearing only very lightweight underwear.

Women who notice they have painful stools around the time of menstruation would be well-advised to begin taking extra dietary fiber and fluids a couple days prior to that time. See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry. Dietary fibers are the indigestible portion of plant foods that move food through the Digestive system, absorbing water and easing Defecation.

Fluids emitted by the intestinal tract may contain irritants that may increase the fissures associated with hemorrhoids. Washing the anus with cool water and soap may reduce the swelling and increase blood supply for quicker healing and may remove irritating fluid.

Kegel exercises for the pelvic floor may also prove helpful. A Kegel exercise, named after Dr Arnold Kegel, consists of contracting and relaxing the muscles which form part of the Pelvic floor (sometimes called the "Kegel

Many people do not get a sufficient supply of dietary fiber (20 to 25 grams daily) and small changes in a person's daily diet can help tremendously in both prevention and treatment of hemorrhoids.

Use of squat toilets

Based on their very low incidence in the developing world, where people squat for bodily functions, hemorrhoids have been attributed to the use of the unnatural "sitting" toilet. [11][12] In 1987, an Israeli physician, Dr. Berko Sikirov, published a study testing this hypothesis by having hemorrhoid sufferers convert to squat toilets. A squat toilet (also known as an Eastern or floor-level toilet is a Toilet used by squatting, rather than sitting. [13] Eighteen of the 20 patients were completely relieved of their symptoms (pain and bleeding) with no recurrence, even 30 months after completion of the study. This chart summarizes the results.

No follow-up studies have ever been published. The American Society of Colon & Rectal Surgeons is silent regarding the therapeutic value of squatting.

Examination

Endoscopic image of internal hemorrhoids seen on retroflexion of the flexible sigmoidoscope at the ano-rectal junction
Endoscopic image of internal hemorrhoids seen on retroflexion of the flexible sigmoidoscope at the ano-rectal junction

After visual examination of the anus and surrounding area for external or prolapsed hemorrhoids, a doctor would conduct a digital examination. Sigmoidoscopy is the Minimally invasive medical examination of the large Intestine from the Rectum through the last part of the colon A rectal examination or rectal exam is an internal examination of the Rectum such as by a Physician or other healthcare professional In addition to probing for hemorrhoidal bulges, a doctor would also look for indications of rectal tumor or polyp, enlarged prostate and abscesses. See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic A polyp is an abnormal growth of tissue ( Tumor) projecting from a Mucous membrane. The prostate (from Greek προστάτης - prostates, literally "one who stands before" "protector" "guardian" is a An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process

Visual confirmation of hemorrhoids can be done by doing an anoscopy, using a medical device called an anoscope. An anoscopy is an examination using a small rigid Speculum (anoscope inserted a few inches into to the Anus in order to evaluate problems of the anal canal This device is basically a hollow tube with a light attached at one end that allows the doctor to see the internal hemorrhoids, as well as polyps in the rectum.

If warranted, more detailed examinations, such as sigmoidoscopy and colonoscopy can be performed. Sigmoidoscopy is the Minimally invasive medical examination of the large Intestine from the Rectum through the last part of the colon Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a Fiber optic In sigmoidoscopy, the last 60cm of the colon and rectum are examined whereas in colonoscopy the entire bowel is examined. The colon is a storage tube for solid wastes The main function of the colon appears to be extraction of Water and salts from Feces.

A pathologist will look for dilated vascular spaces which exhibit thrombosis and recanalization.

Treatments

Treatments for hemorrhoids vary in their cost, risk, and effectiveness. Different cultures and individuals approach treatment differently. Some of the treatments used are listed here in increasing order of intrusiveness and cost.

For many people, hemorrhoids are mild and temporary conditions that heal spontaneously or by the same measures recommended for prevention. There is no medicine that will cure hemorrhoids, but local treatments such as warm sitz baths, using a bidet, extendable showerhead, cold compress, or topical analgesic (such as Nupercainal), can provide temporary relief. Hydrotherapy, formerly called hydropathy involves the use of Water for soothing pains and treating diseases A bidet is a low-mounted Plumbing fixture or type of Sink intended for Washing the Genitalia, inner Buttocks, and Anus. Especially in the case of external hemorrhoids with a visible lump of small size, the condition can be improved with warm bath causing the vessels around rectal region to be relaxed. Consistent use of medicated creams during the early stages of a hemorrhoid flare-up will also provide relief and may stave off further development and irritation. However, creams containing steroid preparations weaken the skin and may contribute to further flare-ups. Keep the area clean and dry, with some lubrication provided by hemorrhoidal creams or a lubricant. Ointment or suppositories such as Proctosedyl[14][15] and Faktu[16] can also relieve the symptoms. A suppository is a drug delivery system that is inserted either into the Rectum (rectal suppository Vagina (vaginal suppository or Urethra (urethral

Natural treatments

Some people claim to have successfully applied natural procedures for treatment or reversal of chronic conditions. These procedures largely echo the prevention measures. However, self-care measures, including herbal or "natural" remedies, should not be undertaken without medical consent to avoid possible drug interactions. They include:

The combination of internal and external remedies is particularly recommended, e. g. , Witch-hazel suppositories combined with frequent cups of strong chamomile tea. [18]

Dietary supplements can help treat and prevent many complications of hemorrhoids, and natural botanicals such as Butchers Broom, Horse-chestnut, and bioflavonoids can be an effective addition to hemorrhoid treatment. [19]

Butcher's Broom extract, or Ruscus aculeatus, contains ruscogenins that have anti-inflammatory and vasoconstrictor effects that help tighten and strengthen veins. Butcher's broom Ruscus aculeatus, Ruscaceae, formerly in Liliaceae) is a low Evergreen Eurasian Shrub of the Lily Butcher’s Broom has traditionally been used to treat venous problems including hemorrhoids and varicose veins. [20][21][22]

Horse-chestnut extract, or Aesculus hippocastanum, contains a saponin known as aescin, that has anti-inflammatory, anti-edema, and venotonic actions. Saponins are a class of chemical compounds one of very many Secondary metabolites found in natural sources with saponins found in particular abundance in various plant Aescin improves tone in vein walls, thereby strengthening the support structure of the vein. Double blind studies have shown that supplementation with Horse-chestnut helps relieve the pain and swelling associated with chronic venous insufficiency. [23][24]

Bilberry extract, or Vaccinium myrtillus, is an anthocyanoside bioflavonoid. Supplementation with this potent flavonoid protects and maintains venous strength and function. [20][25]

Surgical and non-medicinal treatments

Some people require the following medical treatments for chronic or severe hemorrhoids:

Diseases with similar symptoms

Symptoms associated with rectal cancer, anal fissure, anal abscess, anal fistula, Perianal hematoma, and other diseases may be similar to those produced by hemorrhoids and may be reduced by the topical analgesic methods described above. Colorectal cancer, also called colon cancer or large bowel cancer, includes Cancerous growths in the colon, Rectum and An anal fissure is an unnatural crack or tear in the Anus skin Note This article is meant to generally encompass the conditions generally known variously as "anal abscess" "rectal abscess" "peri-rectal abscess" "ano-rectal An Anal Fistula is an abnormal connection between the Epithelialised surface of the Anal canal and (usually the Perianal skin A Perianal hematoma is a type of Hematoma located in or on the border of the Anus. For this reason, it is a good idea to consult with a physician when these symptoms are encountered, particularly for the first time, and periodically should the problem continue. In the US, colonoscopy is recommended as a general diagnostic for those over age 50 (40 with family history of bowel cancers); a clear (normal) scope is good for 10 years.

References

  1. ^ MedlinePlus Medical Encyclopedia:Hemorrhoid surgery - series: Normal anatomy
  2. ^ Perianal hematoma - Medbroadcast
  3. ^ a b Hemorrhoid at eMedicine
  4. ^ Johanson JF, Sonnenberg A (1990). eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors "The prevalence of hemorrhoids and chronic constipation. An epidemiologic study". Gastroenterology 98 (2): 380–6. PMID 2295392.  
  5. ^ Burkitt, DP, Varicose Veins, Deep Vein Thrombosis, and Haemorrhoids: Epidemiology and Suggested Aetiology,Br Med J. 1972 June 3; 2(5813): 556–561. link to article
  6. ^ Harms R (November 3, 2007). Hemorrhoids during pregnancy: Treatment options. MayoClinic. Retrieved on 2007-11-28. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. For the town in Argentina, see 28 de Noviembre. Events
  7. ^ Causes of Hemorrhoids. Mayo Clinic (November 28, 2006). Retrieved on 2007-12-07. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 43 BC - Marcus Tullius Cicero assassinated 1696 - Connecticut Route 108, one of the oldest highways
  8. ^ Burney RE (November 2005). Hemorrhoids. University of Michigan Health System. Retrieved on 2007-11-28. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. For the town in Argentina, see 28 de Noviembre. Events
  9. ^ E. Gojlan, Pathology, 2nd ed. Mosby Elsevier, Rapid Review series.
  10. ^ Banov L, Knoepp LF, Erdman LH, Alia RT (1985). "Management of hemorrhoidal disease". J S C Med Assoc 81 (7): 398–401. PMID 3861909.  
  11. ^ Sikirov BA (1989). "Primary constipation: an underlying mechanism". Med. Hypotheses 28 (2): 71–3. doi:10.1016/0306-9877(89)90016-9. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 2927355.  
  12. ^ Sikirov D (2003). "Comparison of straining during defecation in three positions: results and implications for human health". Dig. Dis. Sci. 48 (7): 1201–5. doi:10.1023/A:1024180319005. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 12870773.  
  13. ^ Sikirov BA (1987). "Management of hemorrhoids: a new approach". Isr. J. Med. Sci. 23 (4): 284–6. PMID 3623887.  
  14. ^ Proctosedyl ointment/suppositories
  15. ^ Proctosedyl - Drugs - Medbroadcast
  16. ^ http://www.vghks.gov.tw/ph/%E8%99%95%E6%96%B9%E9%9B%86/drug/faktu.htm
  17. ^ Christine Dimmer, Brian Martin, Noeline Reeves and Frances Sullivan (October 1996). "Squatting for the Prevention of Hemorrhoids". Townsend Letter for Doctors & Patients (159): 66-70.  
  18. ^ K. Kraft and C. Hobbs, Pocket Guide to Herbal Medicine. New York: Thieme.
  19. ^ MacKay D (2001). "Hemorrhoids and varicose veins: a review of treatment options" (PDF). Altern Med Rev 6 (2): 126–40. PMID 11302778.  
  20. ^ a b (1998) in Pizzorno JE and Murray MT, eds. : Encyclopedia of Natural Medicine, revised 2nd edition, CA: Prima Publishing, 829.  
  21. ^ Rudofsky G (1989). "[Improving venous tone and capillary sealing. Effect of a combination of Ruscus extract and hesperidine methyl chalcone in healthy probands in heat stress]" (in German). Fortschr. Med. 107 (19): 52, 55–8. PMID 2668140.  
  22. ^ Cappelli R, Nicora M, Di Perri T (1988). "Use of extract of Ruscus aculeatus in venous disease in the lower limbs". Drugs Exp Clin Res 14 (4): 277–83. PMID 3048951.  
  23. ^ Pittler MH, Ernst E (1998). "Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review". Arch Dermatol 134 (11): 1356–60. doi:10.1001/archderm.134.11.1356. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 9828868.  
  24. ^ Diehm C, Trampisch HJ, Lange S, Schmidt C (1996). "Comparison of leg compression stocking and oral Horse-chestnut seed extract therapy in patients with chronic venous insufficiency". Lancet 347 (8997): 292–4. doi:10.1016/S0140-6736(96)90467-5. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 8569363.  
  25. ^ Murray MT. (1996). Encyclopedia of Nutritional Supplements. NY: Three Rivers Press, 326.  
  26. ^ Longman RJ, Thomson WH (2006). "A prospective study of outcome from rubber band ligation of piles". Colorectal Dis 8 (2): 145–8. doi:10.1111/j.1463-1318.2005.00873.x. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16412076.  
  27. ^ MacLeod JH (1982). "In defense of cryotherapy for hemorrhoids. A modified method". Dis. Colon Rectum 25 (4): 332–5. PMID 6979469.  
  28. ^ Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S (2006). "Doppler-guided hemorrhoidal artery ligation". Am. J. Surg. 191 (1): 89–93. doi:10.1016/j.amjsurg.2005.10.007. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16399113.  

See also

External links

An anal fissure is an unnatural crack or tear in the Anus skin An Anal Fistula is an abnormal connection between the Epithelialised surface of the Anal canal and (usually the Perianal skin A Perianal hematoma is a type of Hematoma located in or on the border of the Anus. Proctoscopy is a common medical procedure in which an instrument called a proctoscope (also known as a rectoscope is used to examine the Anal cavity, Rectum or Note This article is meant to generally encompass the conditions generally known variously as "anal abscess" "rectal abscess" "peri-rectal abscess" "ano-rectal The Open Directory Project ( ODP) also known as dmoz (from directory

Dictionary

hemorrhoid

-noun

  1. (usually plural) An engorged, dilated and easily broken varicosity in the perianal area, often accompanied by intense itching and throbbing pain: piles.
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