Hemorrhoids: Clinical manifestations and diagnosis
- Ronald Bleday, MD
Ronald Bleday, MD
- Associate Professor of Surgery
- Harvard Medical School
- Elizabeth Breen, MD
Elizabeth Breen, MD
- Assistant Professor of Surgery
- Harvard Medical School
The cardinal features of hemorrhoidal disease include bleeding, anal pruritus, prolapse, and pain due to thrombosis. This topic will review the anatomic classification, clinical manifestations, and diagnosis of hemorrhoids. The medical and surgical management of hemorrhoids are discussed in detail, separately. (See "Treatment of hemorrhoids" and "Surgical treatment of hemorrhoidal disease".)
●Hemorrhoids are normal vascular structures in the anal canal, arising from a channel of arteriovenous connective tissues that drains into the superior and inferior hemorrhoidal veins
●External hemorrhoids are located distal to the dentate line
●Internal hemorrhoids are located proximal to the dentate line
●Mixed hemorrhoids are located both proximal and distal to the dentate line
- Banov L Jr, Knoepp LF Jr, Erdman LH, Alia RT. Management of hemorrhoidal disease. J S C Med Assoc 1985; 81:398.
- Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 1990; 98:380.
- Haas PA, Fox TA Jr, Haas GP. The pathogenesis of hemorrhoids. Dis Colon Rectum 1984; 27:442.
- Miles WE. Observations upon internal piles. Surg Gynecol Obstet 1919; 29:497.
- Arabi Y, Alexander-Williams J, Keighley MR. Anal pressures in hemorrhoids and anal fissure. Am J Surg 1977; 134:608.
- Thomson WH. The nature of haemorrhoids. Br J Surg 1975; 62:542.
- Morinaga K, Hasuda K, Ikeda T. A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 1995; 90:610.
- Riss S, Weiser FA, Schwameis K, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis 2012; 27:215.
- Kluiber RM, Wolff BG. Evaluation of anemia caused by hemorrhoidal bleeding. Dis Colon Rectum 1994; 37:1006.
- Mounsey AL, Halladay J, Sadiq TS. Hemorrhoids. Am Fam Physician 2011; 84:204.
- Kelly SM, Sanowski RA, Foutch PG, et al. A prospective comparison of anoscopy and fiberendoscopy in detecting anal lesions. J Clin Gastroenterol 1986; 8:658.
- Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993; 328:1365.
- Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996; 348:1472.
- Kronborg O, Fenger C, Olsen J, et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996; 348:1467.
- Korkis AM, McDougall CJ. Rectal bleeding in patients less than 50 years of age. Dig Dis Sci 1995; 40:1520.
- CLINICAL MANIFESTATIONS
- Diagnostic evaluation
- - History
- - Physical examination
- - Anoscopy
- - Laboratory evaluation
- - Endoscopic evaluation
- DIFFERENTIAL DIAGNOSIS
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