Highlights & Basics
- Hemorrhoids are vascular-rich connective tissue cushions located within the anal canal. Internal hemorrhoids lie proximal to the dentate line in the anal canal; external hemorrhoids are located distal to the dentate line.
- Hemorrhoidal disease presents as painless rectal bleeding or sudden onset of perianal pain with a tender palpable perianal mass.
- Diagnosis is confirmed with visualization of the protruding tissue or anoscopic visualization.
- Treatment for all patients includes increasing dietary fiber. Rubber band ligation is a reasonable first-line treatment choice for grade 2 and 3 internal hemorrhoids. Other treatment options for grade 2 or 3 hemorrhoids include sclerotherapy, infrared coagulation, or hemorrhoidal arterial ligation. Surgical hemorrhoidectomy may be considered for patients with large grade 3 hemorrhoids, but it is typically reserved for patients with grade 4 hemorrhoids.
- Complications include recurrence or worsening of symptoms, excessive bleeding, nonreducible prolapse, and, rarely, pelvic sepsis.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
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Citations
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Hawkins AT, Davis BR, Bhama AR, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Dis Colon Rectum. 2024 May 1;67(5):614-23.[Full Text]
van Tol RR, Kleijnen J, Watson AJM, et al. European Society of Coloproctology: guideline for haemorrhoidal disease. Colorectal Dis. 2020 Jun;22(6):650-62.[Abstract]
Shanmugam V, Thaha MA, Rabindranath KS, et al. Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD005034.[Abstract][Full Text]
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