Hemorrhoids represent abnormal tissue in the anal canal which is vascular. Hemorrhoids can be classified as internal when they occur above the anus and external when they are present outside of the anal canal.
Hemorrhoids may not produce any symptoms in most people. Enlarged internal hemorrhoids can cause painless rectal bleeding. External hemorrhoids may become swollen and painful when a clot forms within the vein. This is a condition called thrombosis.
Hemorrhoids can typically be diagnosed by physical examination or a limited evaluation of the anal canal with an anoscope or flexible sigmoidoscope or colonoscope.
Bleeding internal hemorrhoids will often respond to increase in dietary fiber and fluids. Persistent bleeding may require medicated suppositories. If these measures are ineffective, the hemorrhoids can be treated with rubber band ligation or infrared coagulation. Both are relatively simple and painless office-based procedures. Persistent or prolapsing hemorrhoids may require surgical removal.
Thrombosed external hemorrhoids may respond to conservative measures such as Sitz baths and anti-inflammatory creams. Severely painful or refractory thrombosed hemorrhoids may require surgical excision to remove the retained clot.