Bleeding Hemorrhoids



Hemorrhoids are formed when fibromuscular cushions normally lining the anal canal become pathologically engorged leading to symptoms of bleeding, pruritis, and pain. These cushions serve to aid with control of continence and evacuation of formed stool without mucosal injury [1]. They are classically located in three positions: right anterior, right posterior, and left lateral [2]. There are two classes of hemorrhoids that can cause significant symptoms: internal and external, divided based on their position relative to the dentate line (Fig. 1).


Digital Rectal Examination Dentate Line Staple Hemorrhoidopexy Internal Hemorrhoid External Hemorrhoid 
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  1. 1.
    Gearhart SL. Symptomatic hemorrhoids. Dis Mon 2004;50:603–617.CrossRefPubMedGoogle Scholar
  2. 2.
    Beck DE. Benign anal, rectal and perineal problems. In ACS Surgery: Principles and Practice. Lewiston: BC Decker, Inc.; 2007, Section 5,  Chapter 17.
  3. 3.
    Nelson H and Cima R. Anus. In CM Townsend (ed.), Sabiston Textbook of Surgery, 18th edn. Philadelphia: WB Saunders; 2008, p. 494.Google Scholar
  4. 4.
    American Gastroenterological Association Medical Position Statement. Diagnosis and treatment of hemorrhoids. Gastroenterology 2004;126:1461–1462.CrossRefGoogle Scholar
  5. 5.
    Nelson H. Diseases of the rectum and anus. In L Goldman (ed.), Cecil Medicine, 23rd edn. St. Louis: WB Saunders; 2008, Section XII, Chapter 148.Google Scholar
  6. 6.
    Hull T. Diseases of the anorectum. In M Feldman (ed.), Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 8th edn. Philadelphia: WB Saunders; 2006, p. 2837.Google Scholar
  7. 7.
    Moesgaard F, Nielsen MC, Hansen JB and Knudsen JT. High fiber diet reduces bleeding and pain in patients with hemorrhoids. Dis Colon Rectum 1982;25:454–456.CrossRefPubMedGoogle Scholar
  8. 8.
    Su MY, Chiu CT, Wu CS, et al. Endoscopic hemorrhoidal ligation of symptomatic internal hemorrhoids. Gastrointest Endosc 2003;58:871–874.CrossRefPubMedGoogle Scholar
  9. 9.
    MacRae HM and McLeod RS. Comparison of hemorrhoidal treatments: a meta-analysis. Can J Surg 1997;40:14–17.PubMedGoogle Scholar
  10. 10.
    Fukuda A, Kajiyama T, Arakawa H, et al. Retroflexed endoscopic multiple band ligation of symptomatic internal hemorrhoids. Gastrointest Endosc 2004;59:380–384.CrossRefPubMedGoogle Scholar
  11. 11.
    Law WI and Chu KW. Triple rubber band ligation for hemorrhoids: prospective, randomized trial of use of local anesthetic injection. Dis Colon Rectum 1999;42:363–366.CrossRefPubMedGoogle Scholar
  12. 12.
    Liu J, Petersen BT, Tierney WM, Chuttani R, DiSario JA, Coffie J, Mishkin DS, Shah RJ, Somogyi L and Song LMW. Endoscopic banding devices. Gastrointest Endos 2008;68:217–221.CrossRefGoogle Scholar
  13. 13.
    Bat L, Melzer E, Koler M, Dreznick Z and Shemesh E. Complications of rubber band ligation of symptomatic internal hemorrhoids. Dis Colon Rectum 1993;36:287–290.CrossRefPubMedGoogle Scholar
  14. 14.
    Randall FM, Jensen DM, Machicado GA, Hirabayashi K, Jensen ME, You S and Pelayo E. Prospective randomized comparative study of bipolar versus direct current electrocoagulation for treatment of bleeding internal hemorrhoids. Gastrointest Endosc 1994;40:403–410.CrossRefPubMedGoogle Scholar
  15. 15.
    Oh C. Problems of cryohemorrhoidectomy. Cryobiology 1982;19:283–286.CrossRefPubMedGoogle Scholar
  16. 16.
    Bronstein M, Issa N, Gutman M and Neufeld D. Ligation under vision of haemorrhoidal cushions for therapy of bleeding haemorrhoids. Tech Coloproctol 2008;12:119–122.CrossRefPubMedGoogle Scholar
  17. 17.
    Felice G, Privitera A, Ellul E and Klaumann M. Doppler-guided hemorrhoidal artery ligation: an alternative to hemorrhoidectomy. Dis Colon Rectum 2005;48:2090–2093.CrossRefPubMedGoogle Scholar
  18. 18.
    Acheson AG and Scholefield JH. Management of haemorrhoids. BMJ 2008;336:380–383.CrossRefPubMedGoogle Scholar
  19. 19.
    Milligan ET, Morgan CN, Jones LE and Officer R. Surgical anatomy of the anal canal and the operative treatment of hemorrhoids. Lancet 1937;2:1119–1124.CrossRefGoogle Scholar
  20. 20.
    Ferguson JA and Heaton JR. Closed hemorrhoidectomy. Dis Colon Rectum 1959;2:176–179.CrossRefPubMedGoogle Scholar
  21. 21.
    Zaheer S, Reilly WT, Penbetron JH and Ilstrup D. Urinary retention after operations for benign anorectal diseases. Dis Colon Rectum 1998;41:696–704.CrossRefPubMedGoogle Scholar
  22. 22.
    Arbman G, Krook H and Haapaniemi S. Closed vs. open hemorrhoidectomy-is there any difference? Dis Colon Rectum 2000;43:31–34.CrossRefPubMedGoogle Scholar
  23. 23.
    Guenin MO, Rosenthal R, Kern B, Peterli R, von Flue M and Ackermann C. Long-term results and patient satisfaction after Ferguson’s hemorrhoidectomy. Dis Colon Rectum 2005;48:1523–1527.CrossRefPubMedGoogle Scholar
  24. 24.
    Wang LT, Wu CC, Hsaio CW, Feng CC and Jao SW. A modified Ferguson hemorrhoidectomy for circumferential prolapsed hemorrhoids with skin tags. ASCRS 2007;51:456–461.Google Scholar
  25. 25.
    Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapsed with a circular suturing device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery, Rome, Italy; 1998 Jun 3–6.Google Scholar
  26. 26.
    Knight JS, Senapati A and Lamparelli MJ. National UK audit of procedure for prolapsing haemorrhoids on behalf of the Association of Coloproctology of Great Britain and Ireland. Colorect Dis 2007;10:440–445.CrossRefGoogle Scholar
  27. 27.
    Shao WJ, Li GC, Zhang ZH, Yan BL, Sun GD and Chen YQ. Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorroidectomy. Brit J Surg 2008;95:147–160.CrossRefPubMedGoogle Scholar
  28. 28.
    Singer M and Cintron J. New techniques in the treatment of common perianal diseases: staple hemorrhoidopexy, botulinum toxin, and fibrin sealant. Surg Clin NA 2006;86:937–967.CrossRefGoogle Scholar
  29. 29.
    Maw A, Kong-Weng E and Seow-Cohen F. Retroperitoneal sepsis complicating stapled hemorrhoidectomy. Dis Colon Rectum 2002;45(6):826–828.CrossRefPubMedGoogle Scholar
  30. 30.
    Malloy RG and Kingsmore K. Life-threatening pelvic sepsis after stapled hemorrhoidectomy. Lancet 2000;355:810.CrossRefGoogle Scholar
  31. 31.
    Ho HY, Cheong WK, Tsang C, et al. Staple hemorrhoidectomy: cost and effectiveness. Randomized controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum 2000;43:1666–1675.CrossRefPubMedGoogle Scholar
  32. 32.
    Ceci F, Picchio M, Palimento D, Cali B, Corelli S and Spaziani E. Long-term outcome of stapled hemorrhoidopexy for grade III and grade IV hemorrhoids. ASCRS 2008;51:1107–1112.Google Scholar
  33. 33.
    Stolfi V, Sileri P, Micossi C, Carbonaro I, Venza M, Gentileschi P, Rossi P, Falchetti A and Gaspari A. Treatment of hemorrhoids in day surgery: stapled hemorrhoidopexy vs Milligan-Morgan hemorrhoidectomy. J Gastrointest Surg 2008;12:795–801.CrossRefPubMedGoogle Scholar
  34. 34.
    Cataldo P, Ellis CN, Gregorcyk S, Hyman N, Guie WD, Church J, Cohen J, Fleshner P, Kilkenny J, Ko C, Levien D, Nelson R, Newstead G, Orsay C, Perry WB, Rakinic J, Sellito P, Strong S, Ternent C, Tjandra J and Whiteford M. Practice parameters for the management of hemorrhoids (revised). Dis Colon Rectum 2005;48:189–194.CrossRefPubMedGoogle Scholar
  35. 35.
    Kaidar-Person O, Person B and Wexner SD. Hemorrhoidal disease: a comprehensive review. J Am Coll Surg 2007;204:102–117.CrossRefPubMedGoogle Scholar
  36. 36.
    Wehrmann T, Riphaus A, Feinstein J, et al. Hemorrhoidal elastic band ligation with flexible video endoscopes: a prospective, randomized comparison with the conventional technique that uses rigid proctoscopes. Gastrointest Endosc 2004;60:191–195.CrossRefPubMedGoogle Scholar
  37. 37.
    Su MY, Tung SY, Wu CS, et al. Long-term results of endoscopic hemorrhoidal ligation: two different devices with similar results. Endoscopy 2003;35:416–420.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of SurgeryDuke University Medical CenterDurhamUSA

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