Hemorrhoids occur when veins around the anus or lower rectum become swollen and inflamed. They appear either inside the anus or under the skin around it. Hemorrhoids occur in both men and women. Before they reach the age of 50, approximately 50% of all Americans will have had hemorrhoids. Types of hemorrhoids include external hemorrhoids and internal hemorrhoids.
External hemorrhoids are those that occur outside the anal verge. Specifically they are varicosities of the veins draining the territory of the inferior rectal arteries, which are branches of the pudendal artery. They are sometimes painful, and can be accompanied by swelling and irritation. Itching, although often thought to be a symptom of external hemorrhoids, is more commonly due to skin irritation. External hemorrhoids are prone to thrombosis: if the vein ruptures and/or a blood clot develops, the hemorrhoid becomes a thrombosed hemorrhoid.
Internal hemorrhoids are those that occur inside the rectum. Specifically they are varicosities of veins draining the territory of branches of the superior rectal arteries. As this area lacks pain receptors, internal hemorrhoids are usually not painful and most people are not aware that they have them. Internal hemorrhoids, however, may 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 so 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.
The most common grading system was developed by Banov. Grading of internal hemorrhoids are as following. Grade I: The hemorrhoids do not prolapse. Grade II: The hemorrhoids prolapse upon defecation but spontaneously reduce. Grade III: The hemorrhoids prolapse upon defecation, but must be manually reduced. Grade IV: The hemorrhoids are prolapsed and cannot be manually reduced.
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