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Anorectal Disorders

Hemorrhoids

Hemorrhoids are dilated veins located beneath the lining of the anal canal.

Internal hemorrhoids are located in the upper anal canal. External are located in the lower canal.

Internal become symptomatic when constipation causes disruption of the supporting tissues and resultant prolapse and excessive of the vascular cushions fissure.

The most common symptom of internal is painless rectal bleeding, which is usually bright red and ranges from a few drops to a spattering stream at the end of defecation.

If internal remain prolapsed, a dull aching may occur.

Blood and mucus stains may appear on underwear, and itching in the perianal region is common.

Classification

                Grade

                		 Description Symptoms
                1 Non-prolapsing Minimal bleeding
                2 Prolapse with straining, reduce when spontaneously prolapsed, fissure Bleeding, discomfort, pruritus
                3

                Prolapse with straining, manual reduction require when prolapsed

                		 Bleeding, discomfort, pruritus
                4 Cannot be reduced when prolapsed Bleeding, discomfort, pruritus

                   

Management of Internal Hemorrhoids

Grade 1 and uncomplicated grade 2 are treated with avoidance of nonsteroidal anti-inflammatory drugs and dietary modification (increased fiber and fluids and avoidance of binding, spicy, and fatty foods).

Symptomatic grade 2 and grade 3

Treatment