by Richard Hill

Hemorrhoids are a condition whereby you have dilated blood vessels underneath the lining of the skin in your anus or in your rectum. Usually, this inflamed tissue is spongy vascular tissue that has several direct arteriovenous links. Hippocrates himself actually coined the term hemorrhoid, from the Greek words “hema,” which means “blood,” and “rhoos,” which means “flowing.”

Both men and women can have this kind of disease and it is extremely common and likely to be present in more than 50 percent of the population by 50 years of age. Traditionally, hemorrhoids have been referred as varicose veins of the rectum or varicosities of the hemorrhoid tissue.

All through history, hemorrhoids have plagued humankind, possibly beginning when we first learned how to be in upright position. During the Middle times, hemorrhoids were identified as St. Fiacre’s curse (St Fiacre, patron saint of gardeners, contracted a terrible case of prolapsed hemorrhoids after a day of toiling his garden).

There are usually two classifications of hemorrhoids namely internal and external hemorrhoids. The internal hemorrhoids are those that take place above the anal sphincter and those that take place below the anal sphincter are coined as external hemorrhoids. A single person can suffer from both forms at the same time. Though typically, hemorrhoids are considered chronic health problems, they may trigger acute episodes.

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.

The second form, external hemorrhoids, occurs outside the anal verge. Occasionally, it is painful, and can be experienced with swelling and irritation. Although itching occurs, it is not a symptom of hemorrhoid but is usually due to skin irritation. If the dilated vein ruptures and/or develops a blood clot, it will be termed as thrombosed hemorrhoid (most often occurs on external hemorrhoids).

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.

For most women on their first pregnancy, they experience hemorrhoids during the last trimester. Suggested potential causes are impediment of venous return by the gravid uterus, hormonal changes and chronic straining. Although the real etiology is unknown, once the woman has given birth, the majority of hemorrhoidal symptoms subside. In unusual cases, a surgery called hemorrhoidectomy may possibly be necessary and can be performed with minimum morbidity and little threat to the fetus.

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