Internal hemorrhoids are highly vascularized submucosal cushio | Surgery videos & books

Internal hemorrhoids are highly vascularized submucosal cushions located in the anal canal. They are classified as first degree if no prolapse is present; second degree if prolapse occurs with spontaneous reduction; third degree if they require manual reduction; and fourth degree if they are irreducible. Treatment is based on the symptoms and degree of prolapse.Nearly all patients with first- and seconddegree hemorrhoids should initially be placed on a trial of conservative measures including a bowel management program with high fiber diet to avoid straining and constipation, frequent warm baths, and an anti-inflammatory topical cream. If symptoms continue, both rubber band ligation (a small rubber band is placed at the neck of the hemorrhoid resulting in eventual death and detachment of tissue) and infrared coagulation (controlled burn of the vessels at the neck of the hemorrhoid) are good alternatives to surgical therapy. For refractory first- and second-degree hemorrhoids, most third-degree and all fourth-degree hemorrhoids, surgical hemorrhoidectomy is the treatment of choice. A thrombosed external hemorrhoid is a blood clot resulting in painful swelling of the tightly held anoderm. In most cases conservative management is indicated. Excision is reserved for patients with debilitating pain or signs of necrosis.