hemorrhoidal

Hemorrhoidal, in medical use, relates to hemorrhoids or the vascular cushions within the anal canal that aid continence. The term often appears in descriptions of hemorrhoidal disease, which involves enlargement, bleeding, or prolapse of these cushions.

Anatomy and types

There are three main hemorrhoidal cushions that form part of normal anatomy. Internal hemorrhoids originate from the superior hemorrhoidal plexus, above the dentate line, and are usually mucosal. External hemorrhoids arise from the inferior plexus, below the dentate line, and are covered by squamous epithelium. Internal hemorrhoids are typically painless but may bleed or protrude (prolapse) with straining. External hemorrhoids tend to be painful, especially if thrombosed.

Causes, risk factors, and presentation

Enlargement or prolapse of hemorrhoidal tissue is associated with increased venous pressure and straining during bowel movements. Common risk factors include constipation, chronic diarrhea, pregnancy, obesity, aging, and a low-fiber diet. Symptoms vary: internal hemorrhoids often present with bright red bleeding on toilet paper or in the stool, and sometimes prolapse; external hemorrhoids cause localized anal pain, swelling, or a lump, and may be acutely painful if thrombosed.

Diagnosis and management

Diagnosis is based on history and a physical exam, with digital rectal examination and anoscopy or proctoscopy used to evaluate internal hemorrhoids. Colonoscopy or sigmoidoscopy may be recommended for age- or symptom-related cancer screening or if additional intestinal disease is suspected.

Treatment ranges from lifestyle measures to procedures. Conservative care includes high-fiber diet, adequate fluids, bowel regimens, and topical therapies for symptoms. Office-based procedures include rubber band ligation, sclerotherapy, and infrared coagulation. More advanced cases may require hemorrhoidectomy or stapled hemorrhoidopexy. Thrombosed external hemorrhoids may be treated with prompt surgical excision if indicated.

Prognosis and prevention

With appropriate management, most cases resolve or become manageable. Prevention focuses on fiber-rich diets, hydration, regular bowel habits, and avoiding prolonged straining.