also called pilesare swollen and inflamed veins in the anus and lower rectum In their physiological state they act as cushions composed of arterio-venous channels and connective tissue that aid the passage of stool

These cushions support distal anastomoses between the superior rectal arteries and the superior, middle, and inferior rectal veins Normal it provides important sensory information, enabling the differentiation between solid, liquid, and gas

become a pathological disease when they experience abnormal changesHemorrhoids generally cause symptoms when they become enlarged, inflamed, thrombosed, or prolapsed

occur outside the anal verge (the distal end of the anal canal) varicosities of the veins draining the territory of the inferior rectal arteries, which are branches of the internal pudendal artery

painful, and often accompanied by swelling and irritation Itching is more commonly due to skin irritation prone to thrombosis: if the vein ruptures and/or a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid

occur inside the rectumSpecifically they are varicosities of veins draining the territory of branches of the superior rectal arteries usually not painful because this area lacks pain receptorsmay bleed when irritated

Untreated internal hemorrhoids can lead to two severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids Prolapsed hemorrhoids are internal hemorrhoids that are distended that they are pushed outside the anus If the anal sphincter muscle goes into spasm and traps a prolapsed hemorrhoid outside the anal opening, the supply of blood is cut off, and the hemorrhoid becomes a strangulated hemorrhoid

Internal hemorrhoids can be further graded by the degree of prolapse

low-fiber diets cause small-caliber stools, which result in straining during defecation increased pressure causes engorgement of the hemorrhoids, possibly by interfering with venous return Pregnancy and abnormally high tension of the internal sphincter muscle can also cause hemorrhoidal problems

Aging causes weakening of the support structures, which facilitates prolapse Weakening of support structures can occur as early as the third decade of life

A visual examination of the anus and surrounding area may be able to diagnose external or prolapsed hemorrhoidsA rectal exam may be performed to detect possible rectal tumors, polyps, an enlarged prostate, or abscesses Visual confirmation of internal hemorrhoids is via anoscopy

Conservative treatment typically consists of increasing dietary fiber, oral fluids to maintain hydration, non-steroidal anti-inflammatory drugs (NSAID)s and rest Increased fiber intake has been shown to improve outcomes and may be achieved by dietary alterations or the consumption of fibre supplements

Rubber band ligation is a procedure in which elastic bands are applied onto an internal hemorrhoid at least 1cm above the dentate line to cut off its blood supply.Within 57 days, the withered hemorrhoid falls off Cure rate has been found to be about 87%

Sclerotherapy involves the injection of a sclerosing agent (such as phenol) into the hemorrhoidThis causes the vein walls to collapse and the hemorrhoids to shrivel upThe success rate at four years is 70%.

A number of cautery methods have been shown to be effective for hemorrhoidsThis can be done using electrocautery, infrared radiation, or cryosurgery

A number of surgical techniques may be used if conservative medical management failsAll are associated with some degree of complications including urinary retention, due to the close proximity to the rectum of the nerves that supply the bladder, bleeding, infection, and anal strictures

Hemorrhoidectomy is a surgical excision of the hemorrhoid used primary only in severe casesIt is associated with significant post operative pain and usually requires 24weeks for recovery remove excess, swollen tissue that is present in the anal-rectal areaIt is most often applied to the most severe of hemorrhoids, such as those that have prolapsed or are nearing such stage (Grades III and Grades IV).

Stapled hemorrhoidectomy is a procedure that involves resection of soft tissue proximal to the dentate line, disrupting the blood flow to the hemorrhoids. It is generally less painful than complete removal of hemorrhoids and was associated with faster healing compare to a hemorrhoidectomy

The best way to prevent hemorrhoids is to keep stools soft so they pass easily, thus decreasing pressure and straining, and to empty bowels as soon as possible after the urge occurs Exercise, including walking, and increased fiber in the diet help reduce constipation and straining by producing stools that are softer and easier to pass.Spending less time attempting to defecate and avoiding reading while on the toilet have been recommended