Hemorrhoids Tend to Bleed

Hemorrhoids are dilated venous channels of the hemorrhoidal plexuses. They result from
downward displacement of the anal cushions. Internal hemorrhoids arise from the superior
hemorrhoidal plexus above the pectinate line, whereas external hemorrhoids originate from the
inferior hemorrhoidal plexus below that line. Hemorrhoids are common in Western countries, to
some degree afflicting at least half the population over 50 years. Hemorrhoids are common in
pregnancy, presumably because of the increased abdominal pressure.
Pathology
Microscopic examination of hemorrhoidectomy specimens discloses dilated vascular spaces
with excess smooth muscle in their walls. Hemorrhage and thrombosis of varying severity are
common.
Clinical Features
The salient clinical feature of hemorrhoids is bleeding. Chronic blood loss may lead to iron-
deficiency anemia. Rectal prolapse often develops. Prolapsed hemorrhoids may become
irreducible, and lead to painful strangulated hemorrhoids. Thrombosis of external hemorrhoids is
exquisitely painful and requires evacuation of the intravascular clot.

HEMORRHOIDS: These are dilations of the veins of the rectum and anal canal, and may occur
inside or outside the anal sphincter (see Chapter 13). Although there may be a hereditary
predisposition, the condition is aggravated by factors that increase intra-abdominal pressure,
such as constipation and pregnancy, or venous obstruction by rectal tumors. Hemorrhoids often
bleed, which may be confused with bleeding rectal cancers. Thrombosed hemorrhoids are
exquisitely painful.

Editors: Rubin, Raphael; Strayer, David S.

Title: Rubin's Pathology : Clinicopathologic Foundations of Medicine, 5th Edition
Copyright 2008 Lippincott Williams & Wilkins