The Management of Hemorrhoids

- Introduction

Hemorrhoids are vascular structures that arise from a channel of arteriovenous connective tissues and drain into the superior and inferior hemorrhoidal veins. Although hemorrhoids are categorized as external or internal based on their relationship with the dentate line, they communicate with one another and often coexist, ⁽¹⁾.

The cardinal sign of internal hemorrhoids is painless bleeding with bowel movements; patients may also complain of intermittent tissue protrusion. Constipation and diarrhea are frequent antecedent historical features, ⁽²⁾.

Symptoms related to hemorrhoids are very common in the Western hemisphere and other industrialized societies. Obtaining a thorough personal and family history and performing an adequate physical examination will identify high-risk patients requiring more extensive evaluation.

Hemorrhoids may be treated medically or surgically. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient ⁽³⁾.