Hemorrhoids are normal anatomical structures (vascular pads), which are present from the embryonic stage. They fulfill the main function of contributing through their elasticity to the complete occlusion of the anus, intervening in anal continence.

Speaking from the pathological point of view, hemorrhoids are considered the most frequent disease of the anal region, with a high prevalence and a peak incidence between 45 and 65 years. It is the most frequent anorectal pathology in primary care and predominates in the female sex, they are so frequent that most people suffer from them at some stage of their lives.

The external hemorrhoids are defined as dilations or protuberances of blood vessels of the rectum or anus. They can develop inside the anus (internal hemorrhoids) but external hemorrhoids can protrude or they can develop outside the anus and become covered with skin (external hemorrhoids).

These can be painful, rarely cause long-term health problems, and are not associated with cancer. Sometimes they cause blood to be in the stool . People with hemorrhoids almost never see a doctor because of embarrassment, fear, or ignorance of treatment.

How hemorrhoids are classified

According to your location.

  • Internal: they are covered with mucosa, correspond to the superior hemorrhoidal blood vessels, can be accompanied by mucous discharge and itching.
  • External: the external hemorrhoids are covered with skin, blood vessels correspond to inferioes hemorrhoidal, increase with straining.
  • Mixed: covered with mucosa and skin. It is a combination.

According to the descent.

  • Grade I: they are located in the submucosal tissue, they are only seen at the time of defecation.
  • Grade II: they protrude when defecating but spontaneously reintroduce with the cessation of effort.
  • Grade III: they come out when defecating and are reintroduced manually.
  • Grade IV: not manually reintroduced and prolapsed (always outside).
  • Grade V: hemorrhoidal flux, in addition to being prolapsed, there is infection. The person should go to the doctor immediately, as it is an emergency. 

Causes of hemorrhoids

In general, the causes of external hemorrhoids are related to anything that puts pressure on the veins in the lower body, the most common causes of external hemorrhoids are as follows.

  • Straining during defecation.
  • Sitting on the toilet for long periods of time reading or using electronic equipment such as cell phones in the bathrooms.
  • Constipation or diarrhea.
  • The overweight.
  • The pregnancy.
  • Age, which causes tissue to weaken.
  • Abdominal tumor that hinders venous return.
  • Standing for a long time
  • Constipation (with hard, dry stools).
  • Exaggerated muscle tone of the anal sphincter.

Signs and symptoms

Symptoms of external hemorrhoids include:

  • Bright red drops of blood on toilet paper or in the toilet.
  • Swollen and protruding blood vessels from the anus. Produces a foreign body sensation within the anal canal, anorectal fullness and heaviness.
  • Hard and painful lump near the anus.
  • Pain in general and when defecating; because they are covered with skin, which is rich in nerve endings.
  • Secretion, produced by the mucosa of the prolapse that accompanies this pathology.
  • Anal itching and irritation, secondary to the persistence of the secretion produced by the mucous prolapse. 


            When the hemorrhoidal pathology does not remit, some of the following complications may occur:

  • Chronic or acute anemia (in internal ones, due to bleeding).
  • Hemorrhoidal thrombosis, which can lead to necrosis.
  • Constipation from pain.

Treatment of external hemorrhoids

The main objective of the treatment is to eliminate the symptoms and not to remove the hemorrhoids by their mere presence, unless this is essential. In all cases to treat external hemorrhoids, constipation and frequent diarrhea must be corrected to lead the patient to effortless bowel movement of pasty stools.


  • New eating habits to regulate defecation and increase fluid intake if the cause of hemorrhoids is post-constipation.
  • Laxatives
  • Anti-hemorrhoidal ointments and suppositories.
  • Sitz bath.


  • Infrared photocoagulation: a small burn occurs that fixes the mucosa and prevents constant prolapse.
  • Hemorrhoidectomy: excision of hemorrhoidal bundles.
  • Cryotherapy: freezes hemorrhoidal tissue to produce necrosis.
  • Laser: a new technique for hemorrhoidectomy.
  • Electrocautery

Complications of Hemorrhoidectomy

  • Rectal stricture due to poor healing.
  • Wet anus due to sphincter damage.
  • Pain is the most frequent.
  • Hemorrhage.
  • Infection.
  • Relapse.
  • Prolapse of the mucosa by section of the sphincter.
Dr. Eric Jackson

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses. He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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