The rectum, an organ located at the end of the large intestine, is situated between the colon and anal canal. In hemorrhoids, the veins in the rectum are dilated, twisted and swollen (varicosed). External hemorrhoids are located at the junction of the anal mucosa and the skin, and the location of internal hemorrhoids is the rectum.

Increased intravenous pressure in the hemorrhoidal venous plexus is the probable cause of hemorrhoids. Jobs that require prolonged sitting or standing increase the likelihood of developing hemorrhoids. Other risk factors include: straining due to constipation, diarrhea, coughing, sneezing or vomiting; conditions such as heart failure, hepatic disease, alcoholism and anorectal infections; loss of muscle tone due to age and rectal surgery; anal intercourse; and pregnancy.

Hemorrhoids are often asymptomatic; however, painless bleeding during and following defecation is common. Other manifestations include: rectal pain; rectal itching; and hemorrhoids that protrude and spontaneously shrink. External hemorrhoids are subject to thrombosis and becoming strangulated (blood supply is cut off). These can be severely painful. Internal hemorrhoids leave a sensation of not completely emptying one's bowels.

Physical examination is used to determine the presence of external hemorrhoids, and proctoscopy is used to demonstrate internal hemorrhoids.

Surgical treatment (hemorrhoidectomy) is usually required for severe bleeding, a large prolapse, acute pain, and intractable itching. Treatment measures include: local anesthetics to decrease tissue swelling and pain; witch hazel packs and warm sitz baths to reduce swelling; and the injection of sclerosing agents to produce scar tissue and decrease prolapse.

Patient teaching relative to dietary measures to prevent constipation; precautions related to limiting sitting on the toilet longer than necessary; good anal hygiene with the use of medicated pads; and the use of sitz baths and creams are residual measures used to prevent serious hemorrhoid problems and surgery.

• To properly rate hemorrhoid(s) with manifestation of anemia due to the hemorrhoid(s), do not rate anemia separately as this would constitute pyramiding.

• None.