From the Guidelines
Hemorrhoids belong to the group of vascular disorders affecting the anorectal region, specifically classified as a type of venous disease or vascular condition that affects the hemorrhoidal plexus. They are swollen, inflamed veins in the rectum and anus that can cause discomfort and bleeding. According to the most recent and highest quality study 1, hemorrhoids can be categorized as internal hemorrhoids (occurring inside the rectum) or external hemorrhoids (developing under the skin around the anus). The condition develops when the veins in these areas become enlarged and distended, often due to increased pressure in the lower rectum from straining during bowel movements, chronic constipation, prolonged sitting, pregnancy, or a low-fiber diet.
Some key points to consider when evaluating hemorrhoids include:
- The fundamental pathophysiology involves vascular cushions that become pathologically enlarged and symptomatic due to disruption of the supporting tissues and increased venous pressure 1
- Hemorrhoids are extremely common, affecting a significant portion of the population, with the incidence increasing with age 1
- The diagnosis and treatment of hemorrhoids require a careful anorectal evaluation, including anoscopy and flexible sigmoidoscopy, to rule out other potential causes of symptoms such as inflammatory bowel disease or cancer 1
- Medical and pharmacological therapies, including flavonoids and phlebotonics, may be effective in relieving symptoms and improving outcomes in patients with complicated hemorrhoids 1
In terms of morbidity, mortality, and quality of life, it is essential to prioritize a thorough evaluation and accurate diagnosis to ensure appropriate treatment and prevent complications. As noted in the study by Tarasconi et al. 1, a careful anorectal evaluation is crucial to determine the underlying cause of symptoms and to rule out other potential conditions. By prioritizing a thorough evaluation and accurate diagnosis, healthcare providers can improve patient outcomes and reduce the risk of complications associated with hemorrhoids.
From the Research
Disease Group Classification
Hemorrhoids belong to the group of anorectal disorders.
- Anorectal disorders are commonly encountered in the practice of emergency medicine 2
- Hemorrhoids are the most prevalent anorectal disorder and are the most common cause of hematochezia 2
- Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures become engorged and/or prolapse through the anal canal 3
Characteristics of Anorectal Disorders
- Anorectal disorders can be diagnosed and treated in the emergency department setting 2
- Almost all anorectal disorders once diagnosed and treated in the emergency department need appropriate follow-up to ensure adequacy of treatment, for further possible diagnostic procedures, or for definitive treatment 2
- Other anorectal issues that occur alongside hemorrhoidal issues include anal fissure 4
Treatment Options
- Treatment for symptomatic hemorrhoids should be tailored to patient profile and expectations 3
- Medical management, dietary modifications, and behavioral therapies are the mainstays of initial therapy for hemorrhoids 5
- Office-based treatment of grades I to III internal hemorrhoids with rubber band ligation is a preferred next step if initial therapy is unsuccessful 5