Hemorrhoids
Hemorrhoidal varices are part of the normal anatomy. Dilation and enlargement of the superior plexus of the superior hemorrhoidal veins located above the dentate line produce internal hemorrhoids. Enlargement of the plexus of the inferior hemorrhoidal veins located below the dentate line produces external hemorrhoids. External hemorrhoids may protrude from the rectum. Hemorrhoids occur in both sexes. Incidence is generally highest between ages 20 and 50.
Causes
Hemorrhoids result from activities that increase intravenous pressure, resulting in distention and engorgement. Predisposing factors include prolonged sitting, straining at defecation, constipation, low-fiber diet, pregnancy, and obesity.
Other factors include hepatic disease, such as cirrhosis, amebic abscesses, or hepatitis; alcoholism; and anorectal infections.
Signs and symptoms
Internal hemorrhoids may produce no symptoms. They characteristically cause painless, intermittent bleeding during defecation. Bright red blood appears in stools or on toilet paper because of injury to the fragile mucosa covering the hemorrhoid.
When hemorrhoids prolapse, they’re usually painless and spontaneously return to the anal canal after defecation.
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