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A number of factors may lead to the formation of hemorrhoids. The most common causes are irregular bowel movement (constipation or diarrhea), extreme exercises such as weight lifting, poor nutrition (low-fiber diet), increased intra-abdominal pressure (prolonged straining as in pregnancy), genetics, absence of valves within the hemorrhoidal veins, and aging. Hemorrhoids are more common among the elderly. Some factors that increase the rectal vein pressure resulting in hemorrhoids are obesity and sitting for long periods of time.
Hemorrhoids are common among bus and truck drives and office workers who spend many hours sitting down. During pregnancy, pressure from the fetus on the abdomen and hormonal changes cause the hemorrhoidal vessels to enlarge. Deliver also leads to increased intra-abdominal pressures.
Surgical treatment is rarely needed, as symptoms usually resolve post deliver. Treatment with a cryogenic device such as Anucure is recommended.
External Hemorrhoids are those that occur below the dentate line. They may actually be concealed from view. Specifically, they are varicose veins draining the area of the inferior rectal arteries, which are branches of the internal pudendal artery. they are sometimes painful and often accompanied by swelling.
Itching, although often thought to be a symptom of external hemorrhoids, is more commonly due to skin irritation. The skin irritation may be brought about by the inflammation of the external hemorrhoid, which in turn leads to a barley noticeable watery discharge. External hemorrhoids are prone to thrombosis, which occurs when the vein ruptures or a blood clot develops. Symptoms of external hemmorhoids include painful swelling or lumps around the anus.
The most common symptom of internal hemorrhoids is bright red blood covering the stool, a condition known as hemathochezia, on toilet paper, or in the toilet bowl. Internal hemmorhoids may protrude through the anus and occur above the dentale line. Specifically, they are varicosities of veins draining the area of branches of the superior rectal arteries. As this area lacks pain receptors, internal hemorrhoids are usually not as painful and most people are not aware that they have them. The may, however, 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 strangulated.
Internal hemorrhoids can be further graded by the degree to which they are prolapsed.
Grade I: Not prolapsed
Grade II: Prolapsed upon defecation but spontaneously reduced
Grade III: Prolapsed upon defecation and must be manually reduced
Grade IV: Prolapsed and cannot be manually reduced
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