What Are Hemorrhoids?

Hemorrhoid or hemorrhoids, refers to a condition where there is a presence of masses of dilated blood vessel underneath the lining of the skin in the anal canal or rectum. Studies have documented that the inflamed mass is actually composed of spongy vascular tissue with several direct arteriovenous connections. Hippocrates coined the term hemorrhoids from the Greek words hema meaning blood and rhoos meaning flowing.

Men and women both can have this problem, and it’s extremely common. In fact, more than 50% of the population will have it by the time they’re 50 years of age. Most often, hemorrhoids have been called rectal varicose veins or “varicosities” of hemorrhoid tissue.

Throughout history, hemorrhoids have been a problem for humans, and possibly date back to when we first learned how to walk upright. During the Middle Ages, hemorrhoids were called St. Fiacre’s curse. St. Fiacre was the patron saint of gardeners, and he contracted a terrible case of hemorrhoids that prolapsed after a day of working very hard in his garden.

Hemorrhoids are usually classified as two different types, external and internal. If hemorrhoids are external, they are below the anal sphincter, and if they are internal, they are above the anal sphincter. Typically, hemorrhoids are chronic for people, although they may also be acute.

The first form, internal hemorrhoids, can be found within the right posterior, right anterior and left lateral positions inside the anal canal. The position of hemorrhoids within the anal canal however remains remarkably consistent. Internal hemorrhoids are generally not painful and most people are not conscious that they are inflicted since the area lacks pain receptors. When irritated however, may bleed. If not detected and treated at once, it may lead to severe forms such as strangulated and prolapsed hemorrhoid.

External hemorrhoids, in contrast to their internal cousins, occur on the outside of the anus. These hemorrhoids can be painful, with some swelling and irritation. There can also be itching, although this isn’t necessarily a symptom of hemorrhoids, but can be caused by skin irritation. If the dilated vein develops a blood clot and/or ruptures, it is then called a thrombosed hemorrhoid; thrombosed hemorrhoids usually occur on external hemorrhoids.

Hemorrhoids are classified by history rather than by physical examination. Grade I hemorrhoids bleed but are not prolapsed; Grade II hemorrhoids prolapse and undergo spontaneous reduction. Grade IIIs prolapse and undergo manual reduction, and Grade IVs prolapse irreducibly. These classifications have been around for many years and correspond quite well to treatment algorithms. Quite often, Grades I and II can be treated without surgery, while Grades III and IV will probably require surgery.

Many women experience hemorrhoids during the last trimester of the first pregnancy. Potential causes include impediment of venous return because of the enlarged uterus, hormonal changes because of pregnancy, and chronic straining. It’s not quite known what really causes them, but the majority of these types of hemorrhoid symptoms go away once women have given birth. If symptoms are particularly severe, surgery called a hemorrhoidectomy may be required; this is usually not dangerous to the mother and also poses little risk to the fetus.

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