What You Should Know About Hemorrhoids

What You Should Know About Hemorrhoids

Written By: Robert Ripley, MD

General Surgeon, Wickenburg Community Hospital

Hemorrhoids were considered varicose veins of the anal canal. Now theory describes destruction of anal “cushions”.  The cushions are complexes of blood vessels supported by connective tissue (tissue that supports the body structures).  The loss of this connective tissue allows the blood vessels to slide downward and protrude outward.

Hemorrhoids are classified as external or internal.  External hemorrhoids are enlarged blood vessels that protrude on the outside of the anus, while internal hemorrhoids are located inside the anus canal.  Internal hemorrhoids are further classified by degrees.

  • First degree associated with painless bleeding.
  • Second degree protrude through the anal canal at the time of a bowel movement and reduce spontaneously.
  • Third degree protrude at the time of a bowel movement, but must be manually reduced.
  • Fourth degree protrude all the time and cannot be reduced.

The most common symptoms include painless bleeding, burning, and itching.  Hemorrhoidal pain comes with a thrombosis hemorrhoid which is a hemorrhoid that bleeds beneath the skin forming a painful knot.


Unless hemorrhoids are symptomatic, they do not have to be treated.  For mild bleeding, regulation of diet by increasing the amount of fiber and water consumed can often eliminate these symptoms.  When this is not effective, banding or enlarged hemorrhoids is indicated.  This is an office procedure where an elastic band is placed at the base of the internal hemorrhoid complex causing the hemorrhoid to slough off in 5 to 7 days.

Mixed hemorrhoids (internal and external) are best treated by hemorrhoidectomy.  In this procedure the enlarged hemorrhoids are excised by making an elliptical incision around them and dissecting the underlying blood vessels away from the surrounding muscles.

Thrombosis hemorrhoids cause a painful knot that usually can be treated without surgery.  However if the pain is sever an office procedure can be done under local anesthesia to remove the painful lump.Finally, although hemorrhoids are the most common cause of rectal bleeding, other causes such as cancer, polyps, and inflammatory bowel disease can have similar symptoms.  To eliminate these causes a colonoscopy (using a flexible telescope to view the inside of the colon and rectum) may be necessary.


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