What Are Hemorrhoids, and What Are the Treatments for Them?

By: Richard Hill

hemorrhoids are caused when dilated blood vessels occur under the skin that lines the rectum or anus. Studies have shown that this inflamed tissue is actually a spongy mass of vascular tissue that has several direct arteriovenous connections. Hippocrates himself, the father of modern medicine, created the word "hemorrhoid" when he combined the Greek words "hema," which means blood, and "rhoos," which means 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.
Hemorrhoids have been around since the beginning of mankind, and although their origin isn't specifically known, they began, possibly, when we were first upright. During the Middle Ages, hemorrhoids were called St. Fiacre's curse; St. Fiacre is the gardeners' patron saint, and he contracted a horrible case of prolapsed hemorrhoids after he had spent the day laboring in his garden.
Hemorrhoids are usually classified as two types, either internal or external. If hemorrhoids are internal, they occur above the anal sphincter, while those that occur below the anal sphincter are deemed external. One person can have both forms simultaneously. Typically, hemorrhoids are considered to be a chronic health problem, but you can have them acutely.
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 occur outside of the anal verge. These can be painful, and often have irritation and swelling or with them. They may also itch, although this is not really a symptom of hemorrhoids but instead is because the skin has become irritated. If the dilated veins rupture or if a blood clot develops, this becomes a thrombosed hemorrhoid, a condition that occurs most often with external hemorrhage.
Hemorrhoids are classified by history and not as a result of physical exam. They are graded I through IV, mostly. Grade I may bleed but are not prolapsed, Grade II hemorrhoids are prolapsed and have spontaneous reduction, Grade III are prolapsed but can undergo manual reduction, and Grade IV has irreducible prolapse. These classifications have been around for many years and associate well with the treatment prescribed for each group. Usually, Grade I or II hemorrhoids can be treated effectively without surgery, while Grades III and IV usually will need surgery for intervention.
Often times, women may experience hemorrhoids during their first pregnancy, in the last trimester. The causes for this are not clearly known, but it may be as a result of venous return impediment by the gravid uterus, chronic straining, and/or hormonal changes. Again, the real cause isn't known, but usually, once women have given birth, these hemorrhoidal symptoms go away. In some cases, a form of surgery called a hemorrhoidectomy may be necessary, and can be performed safely, with little risk of death to the mother and with little danger to the fetus.

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