HEMORRHOID DISEASE: DIAGNOSIS TREATMENT AND COMPLICATION MANAGEMENT

Hemorrhoidal_Disease_Bahadir_Egekapak

DIAGNOSIS AND CLASSIFICATION OF HEMORRHOIDAL DISEASES

Sinan Efe Yazıcı

Demiroğlu Science University, Faculty of Medicine, Department of General Surgery, İstanbul, Türkiye

Yazıcı SE. Diagnosis and Classification of Hemorrhoidal Diseases. In: Ege B, editor. Hemorrhoidal Disease: Diagnosis, Treatment and Complication Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.29-35.

ABSTRACT

Hemorrhoidal disease is a prevalent anorectal condition characterized by symptomatic enlargement of vascular cushions in the anal region. Epidemiological data suggest a prevalence of approximately 4.4% in the united States, affecting men and women equally, especially between the ages of 45 and 65. Common risk factors include increased intra-abdominal pressure from constipation, prolonged straining, pregnancy, and obesity, although lifestyle factors such as low-fiber diets, limited physical activity, and tobacco or alcohol use also contribute. Clinical presentation varies based on hemorrhoid type. Internal hemorrhoids often manifest as painless bright red bleeding, itching, and tissue prolapse, while external hemorrhoids may cause pain when thrombosed or inflamed. Accurate diagnosis requires a thorough history to rule out other causes of anorectal bleeding (e.g., colorectal cancer), especially in high-risk patients or those with alarm symptoms. Physical examination includes visual inspection, digital rectal examination to assess sphincter tone and detect any masses or fissures, and anoscopy, which remains the gold standard for evaluating the anal canal and distal rectum. Classification relies on anatomic origin: internal (above the dentate line), external (below the dentate line), or mixed and on the degree of prolapse for internal hemorrhoids, following Goligher’s classification (Grades I to Iv). Recognizing the specific grade and type guides appropriate management strategies, which can range from conservative measures, such as dietary modifications and topical treatments, to more invasive procedures for advanced disease. Early and accurate diagnosis, combined with proper classification, optimizes therapeutic outcomes and helps minimize complications.

Keywords: Hemorrhoidal disease; Anorectal disorders; Goligher classification; Internal hemorrhoid; External hemorrhoid

Referanslar

  1. Hulme-Moir M, Bartolo DC. Hemorrhoids. Gastroenterol Clin North Am. Mar 2001;30(1):183-97. [Crossref]  [PubMed]
  2. Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. Feb 1990;98(2):380-6. [Crossref]  [PubMed]
  3. Burkitt DP. Varicose veins, deep vein thrombosis, and haemorrhoids: epidemiology and suggested aetiology. Br Med J. Jun 3 1972;2(5813):556-61. [Crossref]  [PubMed]  [PMC]
  4. Ferdinande K, Dorreman Y, Roelens K, Ceelen W, De Looze D. Anorectal symptoms during pregnancy and postpartum: a prospective cohort study. Colorectal Dis. Dec 2018;20(12):1109-1116. [Crossref]  [PubMed]
  5. Peery AF, Sandler RS, Galanko JA, et al. Risk Factors for Hemorrhoids on Screening Colonoscopy. PLoS One. 2015;10(9):e0139100. [Crossref]  [PubMed]  [PMC]
  6. Riss S, Weiser FA, Schwameis K, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis. Feb 2012;27(2):215-20. [Crossref]  [PubMed]
  7. Goenka MK, Kochhar R, Nagi B, Mehta SK. Rectosigmoid varices and other mucosal changes in patients with portal hypertension. Am J Gastroenterol. Sep 1991;86(9):1185-9. [PubMed]
  8. Johanson JF, Sonnenberg A. Constipation is not a risk factor for hemorrhoids: a case-control study of potential etiological agents. Am J Gastroenterol. Nov 1994;89(11):1981-6. [PubMed]
  9. Loder PB, Kamm MA, Nicholls RJ, Phillips RK. Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg. Jul 1994;81(7):946-54. [Crossref]  [PubMed]
  10. Pigot F, Siproudhis L, Allaert FA. Risk factors associated with hemorrhoidal symptoms in specialized consultation. Gastroenterol Clin Biol. Dec 2005;29(12):1270-4. [Crossref]  [PubMed]
  11. Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. May 7 2012;18(17):2009-17. [Crossref]  [PubMed]  [PMC]
  12. Chong PS, Bartolo DC. Hemorrhoids and fissure in ano. Gastroenterol Clin North Am. Sep 2008;37(3):627-44, ix. [Crossref]  [PubMed]
  13. Jacobs D. Clinical practice. Hemorrhoids. N Engl J Med. Sep 4 2014;371(10):944-51. [Crossref]  [PubMed]
  14. Kluiber RM, Wolff BG. Evaluation of anemia caused by hemorrhoidal bleeding. Dis Colon Rectum. Oct 1994;37(10):1006-7. [Crossref]  [PubMed]
  15. Mounsey AL, Halladay J, Sadiq TS. Hemorrhoids. Am Fam Physician. Jul 15 2011;84(2):204-10. [PubMed]
  16. Rivadeneira DE, Steele SR, Ternent C, et al. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum. Sep 2011;54(9):1059-64. [Crossref]  [PubMed]
  17. Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal Cancer Incidence Patterns in the United States, 1974-2013. J Natl Cancer Inst. Aug 1 2017;109(8) [Crossref]  [PubMed]
  18. Arora G, Mannalithara A, Mithal A, Triadafilopoulos G, Singh G. Concurrent conditions in patients with chronic constipation: a population-based study. PLoS One. 2012;7(10):e42910. [Crossref]  [PubMed]  [PMC]
  19. Sun Z, Migaly J. Review of Hemorrhoid Disease: Presentation and Management. Clin Colon Rectal Surg. Mar 2016;29(1):22-9. [Crossref]  [PubMed]  [PMC]
  20. Gralnek IM, Ron-Tal Fisher O, Holub JL, Eisen GM. The role of colonoscopy in evaluating hematochezia: a population-based study in a large consortium of endoscopy practices. Gastrointest Endosc. Mar 2013;77(3):410-8. [Crossref]  [PubMed]  [PMC]
  21. Siminoff LA, Rogers HL, Harris-Haywood S. Missed Opportunities for the Diagnosis of Colorectal Cancer. Biomed Res Int. 2015;2015:285096. [Crossref]  [PubMed]  [PMC]
  22. Rex DK, Boland CR, Dominitz JA, et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. Jul 2017;112(7):1016-1030. [Crossref]  [PubMed]
  23. Alonso-Coello P, Castillejo MM. Office evaluation and treatment of hemorrhoids. J Fam Pract. May 2003;52(5):366-74. [PubMed]
  24. Sardinha TC, Corman ML. Hemorrhoids. Surg Clin North Am. Dec 2002;82(6):1153-67, vi. [Crossref]  [PubMed]
  25. Beck DE. Evaluation of the anorectum during endoscopic examinations. Techniques in Gastrointestinal Endoscopy. 2004;6(1):2-5. [Crossref]
  26. Hall JF. Modern management of hemorrhoidal disease. Gastroenterol Clin North Am. Dec 2013;42(4):759-72. [Crossref]  [PubMed]
  27. Kelly SM, Sanowski RA, Foutch PG, Bellapravalu S, Haynes WC. A prospective comparison of anoscopy and fiberendoscopy in detecting anal lesions. J Clin Gastroenterol. Dec 1986;8(6):658-60. [Crossref]  [PubMed]
  28. Guttenplan M. The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist. Curr Gastroenterol Rep. Jul 2017;19(7):30. [Crossref]  [PubMed]
  29. Mott T, Latimer K, Edwards C. Hemorrhoids: Diagnosis and Treatment Options. Am Fam Physician. Feb 1 2018;97(3):172-179. [PubMed]
  30. De Schepper H, Coremans G, Denis MA, et al. Belgian consensus guideline on the management of hemorrhoidal disease. Acta Gastroenterol Belg. Jan-Mar 2021;84(1):101-120. [Crossref]  [PubMed]
  31. Clinical Practice Committee AGA. American Gastroenterological Association medical position statement: Diagnosis and treatment of hemorrhoids. Gastroenterology. May 2004;126(5):1461-2. [Crossref]  [PubMed]