{{Short description|Vascular structures in the anal canal}} {{Redirect|Piles|other uses|Piles (disambiguation)}} {{Pp-move}} {{Pp-semi-indef}} {{Good article}} {{Infobox medical condition (new) | name = Hemorrhoids | synonyms = Haemorrhoids, piles,<ref name=Review09 /> hemorrhoidal disease<ref name=Beck2011 /> | image = Internal and external hemorrhoids.png | caption = Diagram demonstrating the anatomy of both internal and external hemorrhoids | field = [[General surgery]] | pronounce = {{IPAc-en|uk|ˈ|h|ɛ|m|ər|ɔɪ|d|z}} | symptoms = '''Internal''': Painless, bright red [[hematochezia|rectal bleeding]]<ref name=NIH2013/><br />'''External''': Pain and swelling around the [[Human anus|anus]]<ref name=Sun2016 /> | complications = | onset = 45–65 years of age<ref name=Kaidar2007/> | duration = Few days<ref name=NIH2013 /> | causes = Unknown<ref name=Sun2016 /> | risks = [[Constipation]], [[diarrhea]], sitting on the [[toilet]] for long periods, [[pregnancy]]<ref name=NIH2013 /> | diagnosis = Examination, rule out serious causes<ref name=Beck2011 /><ref name=NIH2013 /> | differential = | prevention = | treatment = Increased [[dietary fiber|fiber]], drinking fluids, [[NSAID]]s, rest, surgery, [[hemorrhoidal artery embolization]]<ref name=Review09 /><ref name=NG2011/> | medication = | prognosis = | frequency = 50–66% at some time<ref name=Review09 /><ref name=NIH2013 /> | deaths = }} <!-- Definition and symptoms -->
'''Hemorrhoids''' (or '''haemorrhoids'''), also known as '''piles''', are [[sinusoid (blood vessel)|vascular]] structures in the [[anal canal]].<ref>{{cite book |author = Chen, Herbert |title = Illustrative Handbook of General Surgery |url = https://archive.org/details/illustrativehand00chen |url-access = limited |publisher = Springer |location = Berlin |year = 2010 |page = [https://archive.org/details/illustrativehand00chen/page/n211 217] |isbn = 978-1-84882-088-3 }}</ref><ref name=World09>{{cite journal |last1 = Schubert |first1 = MC |last2 = Sridhar |first2 = S |last3 = Schade |first3 = RR |last4 = Wexner |first4 = SD |title = What every gastroenterologist needs to know about common anorectal disorders |journal = World J Gastroenterol |volume = 15 |issue = 26 |pages = 3201–09 |date = July 2009 |pmid = 19598294 |pmc = 2710774 |doi = 10.3748/wjg.15.3201 |issn = 1007-9327 |doi-access = free }}</ref> In their normal state, they are cushions that help with [[Human feces|stool]] control.<ref name=Beck2011>{{cite book |last1 = Beck |first1 = David E. |title = The ASCRS textbook of colon and rectal surgery |date = 2011 |publisher = Springer |location = New York |isbn = 978-1-4419-1581-8 |page = 175 |edition = 2nd |url = https://books.google.com/books?id=DhQ1A35E8jwC&pg=PA174 |url-status = live |archive-url = https://web.archive.org/web/20141230143156/https://books.google.ca/books?id=DhQ1A35E8jwC&pg=PA174 |archive-date = 2014-12-30 }}</ref> They become a disease when [[swelling (medical)|swollen]] or [[inflammation|inflamed]]; the unqualified term ''hemorrhoid'' is often used to refer to the disease.<ref name=World09 /> The signs and symptoms of hemorrhoids depend on the type present.<ref name=Sun2016 /> Internal hemorrhoids often result in painless, bright red [[hematochezia|rectal bleeding]] when [[defecation|defecating]].<ref name=NIH2013>{{cite web |title = Hemorrhoids |url = http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/hemorrhoids/Pages/facts.aspx|website = National Institute of Diabetes and Digestive and Kidney Diseases |access-date = 15 February 2016 |date = November 2013 |archive-url = https://web.archive.org/web/20160126115453/http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/hemorrhoids/Pages/facts.aspx |archive-date = 26 January 2016 }}</ref><ref name=Sun2016 /> External hemorrhoids often result in pain and swelling in the area of the [[Human anus|anus]].<ref name=Sun2016 /> If bleeding occurs, it is usually darker.<ref name=Sun2016 /> Symptoms frequently get better after a few days.<ref name=NIH2013 /> A [[skin tag]] may remain after the healing of an external hemorrhoid.<ref name=Sun2016 />
<!-- Cause and diagnosis --> While the exact cause of hemorrhoids remains unknown, a number of factors that increase pressure in the abdomen are believed to be involved.<ref name=Sun2016 /> This may include [[constipation]], [[diarrhea]], and sitting on the [[toilet]] for long periods.<ref name=NIH2013 /> Hemorrhoids are also more common during [[pregnancy]].<ref name=NIH2013 /> Diagnosis is made by looking at the area.<ref name=NIH2013 /> Many people incorrectly refer to any symptom occurring around the anal area as hemorrhoids, and serious causes of the symptoms should be ruled out.<ref name=Beck2011 /> [[Colonoscopy]] or [[sigmoidoscopy]] is reasonable to confirm the diagnosis and rule out more serious causes.<ref name=PG2016>{{cite journal |last1 = Hollingshead |first1 = JR |last2 = Phillips |first2 = RK |title = Haemorrhoids: modern diagnosis and treatment. |journal = Postgraduate Medical Journal |date = January 2016 |volume = 92 |issue = 1083 |pages = 4–8 |pmid = 26561592 |doi = 10.1136/postgradmedj-2015-133328 |s2cid = 207022763 }}</ref>
<!-- Treatment --> Often, no specific treatment is needed and hemorrhoids that do not cause symptoms do not require treatment.<ref name=PG2016 /><ref name="Ashburn 2025">{{cite journal |last1=Ashburn |first1=Jean H. |title=Hemorrhoidal Disease: A Review |journal=JAMA |date=18 August 2025 |doi=10.1001/jama.2025.13083}}</ref> Initial measures consist of increasing [[dietary fiber|fiber]] intake, drinking fluids to maintain hydration, [[Nonsteroidal anti-inflammatory drug|NSAIDs]] to help with pain, and rest.<ref name=Review09 /> Medicated creams may be applied to the area, but their effectiveness is poorly supported by evidence.<ref name=PG2016 /> A number of minor procedures may be performed if symptoms are severe or do not improve with conservative management.<ref name=NG2011 /> [[Hemorrhoidal artery embolization|Hemorrhoidal artery embolization (HAE)]] is a safe and effective [[minimally invasive procedure]] that can be performed and is typically better tolerated than traditional therapies.<ref name=":0" /><ref name=":1" /><ref name=":3" /> Surgery is reserved for those who fail to improve following these measures.<ref name=NG2011>{{cite journal |last = Rivadeneira |first = DE |author2 = Steele, SR |author3 = Ternent, C |author4 = Chalasani, S |author5 = Buie, WD |author6 = Rafferty, JL |author7 = Standards Practice Task Force of The [[American Society of Colon and Rectal Surgeons]] |title = Practice parameters for the management of hemorrhoids (revised 2010) |journal = Diseases of the Colon and Rectum |date = September 2011 |volume = 54 |issue = 9 |pages = 1059–64 |pmid = 21825884 |doi = 10.1097/DCR.0b013e318225513d |s2cid = 29688768 }}</ref>
<!-- Epidemiology and history --> Approximately 50% to 66% of people have problems with hemorrhoids at some point in their lives.<ref name=Review09 /><ref name=NIH2013 /> Males and females are both affected with about equal frequency.<ref name=Review09>{{cite journal |last1 = Lorenzo-Rivero |first1 = S |title = Hemorrhoids: diagnosis and current management |journal = Am Surg |volume = 75 |issue = 8 |pages = 635–42 |date = August 2009 |doi = 10.1177/000313480907500801 |pmid = 19725283 |s2cid = 220122385 |doi-access = free }}</ref> Hemorrhoids affect people most often between 45 and 65 years of age,<ref name=Kaidar2007>{{cite journal |last = Kaidar-Person |first = O |author2 = Person, B |author3 = Wexner, SD |title = Hemorrhoidal disease: A comprehensive review |journal = Journal of the American College of Surgeons |date = January 2007 |volume = 204 |issue = 1 |pages = 102–17 |pmid = 17189119 |url = http://www.siumed.edu/surgery/clerkship/colorectal_pdfs/Hemmorhoids_review.pdf |doi = 10.1016/j.jamcollsurg.2006.08.022 |archive-url = https://web.archive.org/web/20120922155502/http://www.siumed.edu/surgery/clerkship/colorectal_pdfs/Hemmorhoids_review.pdf |archive-date = 2012-09-22 }}</ref> and they are more common among the wealthy,<ref name=Sun2016>{{cite journal |last1 = Sun |first1 = Z |last2 = Migaly |first2 = J |title = Review of Hemorrhoid Disease: Presentation and Management. |journal = Clinics in Colon and Rectal Surgery |date = March 2016 |volume = 29 |issue = 1 |pages = 22–29 |pmid = 26929748 |doi = 10.1055/s-0035-1568144 |pmc = 4755769 }}</ref> although this may reflect differences in healthcare access rather than true prevalence.<ref name="p663" /> Outcomes are usually good.<ref name=NIH2013 /><ref name=PG2016 />
The first known mention of the disease is from a 1700 BC Egyptian [[papyrus]].<ref name="Charles2002(book)">{{cite book |last = Ellesmore, Windsor |title = Surgical Treatment of Haemorrhoids |year = 2002 |publisher = London: Springer |editor = Charles MV |chapter = Surgical History of Haemorrhoids }}</ref> {{TOC limit|3}}
==Signs and symptoms== [[File:M 44 anus 22.jpg|thumb|An [[Perianal hematoma|external hemorrhoid]]]]
In about 40% of people with pathological hemorrhoids, there are no significant symptoms.<ref name=Sun2016 /> Internal and external hemorrhoids may present differently; however, many people may have a combination of the two.<ref name="Ashburn 2025" /><ref name=World09 /> Bleeding enough to cause [[anemia]] is rare,<ref name=Kaidar2007 /> and life-threatening bleeding is even more uncommon.<ref name=AFP2006 /> Many people feel embarrassed when facing the problem<ref name=Kaidar2007 /> and often seek medical care only when the case is advanced.<ref name=World09 />
===External=== If not [[Thrombosis|thrombosed]], external hemorrhoids may cause few problems.<ref name=Day2006 /> However, when thrombosed, hemorrhoids may be very painful.<ref name=Review09 /><ref name=World09 /> Nevertheless, this pain typically resolves in two to three days.<ref name=Kaidar2007 /> The swelling may, however, take a few weeks to disappear.<ref name=Kaidar2007 /> A [[Acrochordon|skin tag]] may remain after healing.<ref name=World09 /> If hemorrhoids are large and cause issues with hygiene, they may produce irritation of the surrounding skin, and thus itchiness around the anus.<ref name=Day2006 />
===Internal=== Internal hemorrhoids usually present with painless, bright red [[rectal bleeding]] during or following a bowel movement.<ref name=World09 /> The blood typically covers the stool, is on the toilet paper, or drips into the toilet bowl.<ref name=World09 /> The stool itself is usually normally colored.<ref name=World09 /> Blood mixed in with the stool is usually due to another cause of bleeding in the gut.<ref name="Ashburn 2025" /> Other symptoms may include mucous discharge, a perianal mass if they [[prolapse]] through the anus, [[Pruritus ani|itchiness]], and [[fecal incontinence]].<ref name=AFP2006>{{cite journal |last = Davies |first = RJ |title = Haemorrhoids. |journal = Clinical Evidence |volume = 74 |date = June 2006 |issue = 15 |pages = 711–24 |pmid = 16973032 |url = http://www.aafp.org/afp/2006/1001/p1168.html |url-status = live |archive-url = https://web.archive.org/web/20130520225522/http://www.aafp.org/afp/2006/1001/p1168.html |archive-date = 2013-05-20 }}</ref><ref>{{cite book |last = Azimuddin |first = Indru Khubchandani, Nina Paonessa, Khawaja |title = Surgical treatment of hemorrhoids |year = 2009 |publisher = Springer |location = New York |isbn = 978-1-84800-313-2 |page = 21 |url = https://books.google.com/books?id=7WC4f7BhChEC&pg=PA21 |edition = 2nd |url-status = live |archive-url = https://web.archive.org/web/20170908184817/https://books.google.com/books?id=7WC4f7BhChEC&pg=PA21 |archive-date = 2017-09-08 }}</ref> Internal hemorrhoids are usually painful only if they become thrombosed or [[necrosis|necrotic]].<ref name=World09 />
==Causes== The exact cause of symptomatic hemorrhoids is unknown.<ref name=CE2009 /> A number of factors are believed to play a role, including irregular bowel habits ([[constipation]] or [[diarrhea]]), lack of exercise, nutritional factors (low-fiber diets), increased intra-abdominal pressure (prolonged straining, [[ascites]], an intra-abdominal mass, or [[pregnancy]]), genetics, an absence of valves within the hemorrhoidal veins, and aging.<ref name=Review09 /><ref name=Kaidar2007 /> Other factors believed to increase risk include [[obesity]], a [[chronic condition|chronic]] [[cough]], and [[pelvic floor dysfunction]].<ref name=Beck2011 /><ref name=World09 /> Squatting while defecating may also increase the risk of severe hemorrhoids.<ref>{{cite book |last1 = Bland |first1 = Kirby I. |last2 = Sarr |first2 = Michael G. |last3 = Büchler |first3 = Markus W. |last4 = Csendes |first4 = Attila |last5 = Garden |first5 = Oliver James |last6 = Wong |first6 = John |title = General Surgery: Principles and International Practice |date = 2008 |publisher = Springer Science & Business Media |isbn = 978-1-84628-832-6 |page = 857 |url = https://books.google.com/books?id=0sdcAQLAc-MC&pg=PA857 |language = en |url-status = live |archive-url = https://web.archive.org/web/20170811182237/https://books.google.ca/books?id=0sdcAQLAc-MC&pg=PA857 |archive-date = 2017-08-11 }}</ref> Evidence for these associations, however, is poor.<ref name=Beck2011 /> Being a receptive partner in [[Anal sex|anal intercourse]] has been listed as a cause.<ref>{{cite book |last1=Bernstein |first1=Melissa |url=https://books.google.com/books?id=ICQPnhr71zwC&dq=hemorrhoids+anal+intercourse&pg=PA115 |title=Nutrition for the Older Adult |last2=Luggen |first2=Ann Schmidt |date=28 January 2011 |publisher=[[Jones & Bartlett Publishers]] |isbn=978-1-4496-6396-4 |page=116 |language=en |access-date=6 July 2023}}</ref>
During pregnancy, pressure from the [[fetus]] on the abdomen and hormonal changes cause the hemorrhoidal vessels to enlarge. The birth of the baby also leads to increased intra-abdominal pressures.<ref>{{cite web |url=http://digestive.niddk.nih.gov/ddiseases/pubs/hemorrhoids/ |title=Hemorrhoids |access-date=18 March 2010 |author=National Digestive Diseases Information Clearinghouse |date=November 2004 |work=[[National Institute of Diabetes and Digestive and Kidney Diseases]] (NIDDK), [[NIH]] |archive-url=https://web.archive.org/web/20100323231446/http://digestive.niddk.nih.gov/ddiseases/pubs/hemorrhoids/ |archive-date=2010-03-23 }}</ref> Pregnant women rarely need surgical treatment, as symptoms usually resolve after delivery.<ref name=Review09 /> A personal history of hemorrhoids or anal fissures, constipation, prolonged straining during delivery, and delivering a larger baby (weighing over 3,800 grams) are risk factors for hemorrhoids during pregnancy and in the post-partum period.<ref name="Ashburn 2025"/>
==Pathophysiology== [[File:Gross pathology of hemorrhoids.jpg|thumb|[[Gross pathology]] of hemorrhoids, showing engorged blood vessels]] Hemorrhoid cushions are a part of normal human anatomy and become a pathological disease only when they experience abnormal changes.<ref name=World09 /> There are three main cushions present in the normal [[anal canal]].<ref name=Review09 /> These are located classically at left lateral, right anterior, and right posterior positions.<ref name=Kaidar2007 /> They are composed of neither [[arteries]] nor [[veins]], but blood vessels called [[sinusoids]], [[connective tissue]], and [[smooth muscle]].<ref name=Beck2011 />{{rp|175}} Sinusoids do not have [[muscle tissue]] in their walls, as veins do.<ref name=World09 /> This set of blood vessels is known as the [[hemorrhoidal plexus]].<ref name=Beck2011 />
Hemorrhoid cushions are important for [[fecal incontinence|continence]]. They contribute to 15–20% of anal closure pressure at rest and protect the [[internal anal sphincter|internal]] and [[external anal sphincter]] muscles during the passage of stool.<ref name=World09 /> When a person bears down, the intra-abdominal pressure grows, and hemorrhoid cushions increase in size, helping maintain anal closure.<ref name=Kaidar2007 /> Hemorrhoid symptoms are believed to result when these vascular structures slide downwards or when venous pressure is excessively increased.<ref name=AFP2006 /> Increased [[internal anal sphincter|internal]] and [[external anal sphincter]] pressure may also be involved in hemorrhoid symptoms.<ref name=Kaidar2007 /> Two types of hemorrhoids occur: internals from the [[superior hemorrhoidal plexus]] and externals from the inferior hemorrhoidal plexus.<ref name=Kaidar2007 /> The [[pectinate line]] divides the two regions, and is also used to divide internal from external hemorrhoids.<ref name=Kaidar2007 /><ref name="Ashburn 2025" />
==Diagnosis== {| class="wikitable" style="float: right; margin-left:15px; text-align:center" |+ Internal hemorrhoid grades !Grade !! Diagram !! Picture |- |1|| [[File:Piles Grade 1.svg|140px]]||[[File:Haemorrhoiden 1Grad endo 01.jpg|140px|Endoscopic view]] |- |2|| [[File:Piles Grade 2.svg|140px]]||[[File:Hemrrhoids 04.jpg|140px]] |- |3|| [[File:Piles Grade 3.svg|140px]]||[[File:Hemrrhoids 05.jpg|140px]] |- |4|| [[File:Piles Grade 4.svg|140px]]||[[File:Piles 4th deg 01.jpg|140px]] |} Hemorrhoids are typically diagnosed by physical examination.<ref name=NG2011 /> A visual examination of the anus and surrounding area may diagnose external or prolapsed hemorrhoids.<ref name=World09 /> Visual confirmation of internal hemorrhoids, on the other hand, may require [[anoscopy]], insertion of a hollow tube device with a light attached at one end.<ref name="Kaidar2007" /> A [[digital rectal exam]] (DRE) can also be performed to detect possible rectal [[tumor]]s, [[polyp (medicine)|polyps]], an enlarged [[prostate]], or [[abscess]]es.<ref name=World09 /> If pain is present, the condition is more likely to be an [[anal fissure]] or external hemorrhoid rather than internal hemorrhoid.<ref name=Kaidar2007 />
===Internal=== {{anchor|Prolapsed hemorrhoid}} Internal hemorrhoids originate above the pectinate line.<ref name=Day2006 /> They are covered by [[columnar epithelium]], which lacks pain [[sensory receptor|receptors]].<ref name=Beck2011 /> They were classified in 1985 into four grades based on the degree of [[prolapse]]:<ref name=Review09 /><ref name=Beck2011 />
* Grade I: No prolapse, just prominent blood vessels<ref name=NG2011 /> * Grade II: Prolapse upon bearing down, but spontaneous reduction * Grade III: Prolapse upon bearing down requiring manual reduction * Grade IV: Prolapse with inability to be manually reduced.
===External=== [[File:Perianal thrombosis 01.jpg|thumb|left|A [[thrombosis|thrombosed]] external hemorrhoid]]
[[Perianal hematoma|External hemorrhoids]] occur below the dentate (or pectinate) line.<ref name=Day2006 /> They are covered proximally by [[anoderm]] and distally by skin, both of which are sensitive to pain and temperature.<ref name=Beck2011 />
===Differential=== Many anorectal problems, including [[anal fissure|fissures]], [[anal fistula|fistulae]], abscesses, [[colorectal cancer]], [[anorectal varices|rectal varices]], and [[pruritus ani|itching]] have similar symptoms and may be incorrectly referred to as hemorrhoids.<ref name=Review09 /> [[Rectal bleeding]] may also occur owing to colorectal cancer, [[colitis]] including [[inflammatory bowel disease]], [[diverticular disease]], and [[angiodysplasia]].<ref name=NG2011 /> If [[anemia]] is present, other potential causes should be considered.<ref name=Kaidar2007 /> Rectal bleeding without bowel movements is unlikely to be due to hemorrhoids.<ref name="Ashburn 2025"/>
Other conditions that produce an anal mass include [[acrochordon|skin tags]], [[anal warts]], [[rectal prolapse]], [[polyp (medicine)|polyps]], and enlarged anal papillae.<ref name=Kaidar2007 /> [[Anorectal varices]] due to [[portal hypertension]] (blood pressure in the [[portal venous system]]) may present similar to hemorrhoids but are a different condition.<ref name=Kaidar2007 /> Portal hypertension does not increase the risk of hemorrhoids.<ref name=Sun2016 />
==Prevention== A number of preventative measures are recommended, including avoiding straining while attempting to defecate, avoiding constipation and diarrhea either by eating a high-fiber diet and drinking plenty of fluid or by taking fiber supplements and getting sufficient exercise.<ref name=Kaidar2007 /><ref>{{cite book |author = Frank J Domino |title = The 5-Minute Clinical Consult 2013 (Griffith's 5 Minute Clinical Consult) |publisher = Lippincott Williams & Wilkins |location = Hagerstown, MD |year = 2012 |page = 572 |isbn = 978-1-4511-3735-4 |url = https://books.google.com/books?id=rrdEq9tb-WYC&pg=PA572 |url-status = live |archive-url = https://web.archive.org/web/20170908184817/https://books.google.com/books?id=rrdEq9tb-WYC&pg=PA572 |archive-date = 2017-09-08 }}</ref> Spending less time attempting to [[defecate]], avoiding reading while on the toilet,<ref name=Review09 /> and losing weight for overweight persons and avoiding heavy lifting are also recommended.<ref>{{cite book |last = Glass |first = Jill C. Cash, Cheryl A. |title = Family practice guidelines |publisher = Springer |location = New York |isbn = 978-0-8261-1812-7 |page = 665 |url = https://books.google.com/books?id=4uKsZZ4BoRUC&pg=PA665 |edition = 2nd |url-status = live |archive-url = https://web.archive.org/web/20170908184817/https://books.google.com/books?id=4uKsZZ4BoRUC&pg=PA665&lpg=PA665 |archive-date = 2017-09-08 |date = 2010-11-18 }}</ref>
==Management== {{anchor|Treatments}}
===Conservative=== Conservative treatment typically consists of foods rich in [[dietary fiber]], intake of oral fluids to maintain hydration, [[nonsteroidal anti-inflammatory drug]]s, [[sitz bath]]s, and rest.<ref name=Review09 /> Increased fiber intake has been shown to improve outcomes<ref name=Alon2005>{{cite journal |last1 = Alonso-Coello |first1 = P. |last2 = Guyatt |first2 = G. H. |last3 = Heels-Ansdell |first3 = D. |last4 = Johanson |first4 = J. F. |last5 = Lopez-Yarto |first5 = M. |last6 = Mills |first6 = E. |last7 = Zhuo |first7 = Q. |last8 = Alonso-Coello |first8 = Pablo |title = Laxatives for the treatment of hemorrhoids |journal = Cochrane Database Syst Rev |issue = 4 |article-number = CD004649 |year = 2005 |volume = 2010 |pmid = 16235372 |doi = 10.1002/14651858.CD004649.pub2 |pmc = 9036624 |editor1-last = Alonso-Coello |editor1-first = Pablo }}</ref> and may be achieved by dietary alterations or the consumption of [[fibre supplements|fiber supplements]].<ref name=Review09 /><ref name=Alon2005 /> Evidence for benefits from sitz baths during any point in treatment, however, is lacking.<ref>{{cite journal |last = Lang |first = DS |author2 = Tho, PC |author3 = Ang, EN |title = Effectiveness of the Sitz bath in managing adult patients with anorectal disorders |journal = Japan Journal of Nursing Science |date = December 2011 |volume = 8 |issue = 2 |pages = 115–28 |pmid = 22117576 |doi = 10.1111/j.1742-7924.2011.00175.x }}</ref> If they are used, they should be limited to 15 minutes at a time.<ref name=Beck2011 />{{rp|182}} Decreasing time spent on the toilet and not straining is also recommended.<ref name=Dav2018>{{cite journal|last1=Davis|first1=BR|last2=Lee-Kong|first2=SA|last3=Migaly|first3=J|last4=Feingold|first4=DL|last5=Steele|first5=SR|title=The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids.|journal=Diseases of the Colon and Rectum|date=March 2018|volume=61|issue=3|pages=284–92|doi=10.1097/DCR.0000000000001030|pmid=29420423|s2cid=4198610}}</ref>
While many [[topical agent]]s and [[suppositories]] are available for the treatment of hemorrhoids, little evidence supports their use.<ref name=Review09 /> As such, they are not recommended by the [[American Society of Colon and Rectal Surgeons]].<ref name="ASCRS2018" /> [[Steroid]]-containing agents should not be used for more than 14 days, as they may cause thinning of the skin.<ref name=Review09 /> Most agents include a combination of active ingredients.<ref name=Beck2011 /> These may include a barrier cream such as [[petroleum jelly]] or [[zinc oxide]], an analgesic agent such as [[lidocaine]], and a [[vasoconstrictor]] such as [[epinephrine]].<ref name=Beck2011 /> Some contain [[Balsam of Peru]] to which certain people may be allergic.<ref name="dermnetnz1">{{cite web |url = http://dermnetnz.org/dermatitis/balsam-of-peru-allergy.html |title = Balsam of Peru contact allergy |publisher = Dermnetnz.org |date = December 28, 2013 |access-date = March 5, 2014 |url-status = live |archive-url = https://web.archive.org/web/20140305094411/http://dermnetnz.org/dermatitis/balsam-of-peru-allergy.html |archive-date = March 5, 2014 }}</ref><ref>{{cite book |title = The ASCRS Textbook of Colon and Rectal Surgery: Second Edition |year = 2011 |isbn = 978-1-4419-1581-8 |url = https://books.google.com/books?id=DhQ1A35E8jwC&pg=PA280 |url-status = live |archive-url = https://web.archive.org/web/20140704121836/http://books.google.com/books?id=DhQ1A35E8jwC&pg=PA280 |archive-date = 2014-07-04 |last1 = Beck |first1 = David E. |last2 = Roberts |first2 = Patricia L. |last3 = Saclarides |first3 = Theodore J. |last4 = Senagore |first4 = Anthony J. |last5 = Stamos |first5 = Michael J. |last6 = Nasseri |first6 = Yosef |publisher = Springer }}</ref>
[[Flavonoids]] are of questionable benefit, with potential side effects.<ref name=Beck2011 /><ref>{{cite journal |vauthors = Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, etal |title = Meta-analysis of flavonoids for the treatment of haemorrhoids |journal = Br J Surg |volume = 93 |issue = 8 |pages = 909–20 |date = August 2006 |pmid = 16736537 |doi = 10.1002/bjs.5378 |s2cid = 45532404 |doi-access = free }}</ref> Symptoms usually resolve following pregnancy; thus active treatment is often delayed until after delivery.<ref>{{cite journal |last = Quijano |first = CE |author2 = Abalos, E |title = Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium |journal = Cochrane Database of Systematic Reviews |date = Jul 20, 2005 |volume = 2012 |issue = 3 |article-number = CD004077 |pmid = 16034920 |doi = 10.1002/14651858.CD004077.pub2 |pmc = 8763308 }}</ref> Evidence does not support the use of [[Traditional Chinese medicine|traditional Chinese herbal treatment]].<ref>{{Cite journal|issue = 10|article-number = CD006791|last1=Gan|first1=Tao|last2=Liu|first2=Yue-dong|last3=Wang|first3=Yiping|last4=Yang|first4=Jinlin|date=2010-10-06|language=en|doi=10.1002/14651858.cd006791.pub2|pmid = 20927750|title = Traditional Chinese Medicine herbs for stopping bleeding from haemorrhoids|journal = Cochrane Database of Systematic Reviews}}</ref>
The use of [[phlebotonics]] has been investigated in the treatment of low-grade hemorrhoids with a Cochrane review showing improvement in overall symptoms, including bleeding and itching. However there were no improvements in pain. The authors noted that more research was needed on the role of phlebotonics in the management of hemorrhoids.<ref name="ASCRS2018">{{cite journal |last1=Davis |first1=BR |last2=Lee-Kong |first2=SA |last3=Migaly |first3=J |last4=Feingold |first4=DL |last5=Steele |first5=SR |title=The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. |journal=Diseases of the Colon and Rectum |date=March 2018 |volume=61 |issue=3 |pages=284–292 |doi=10.1097/DCR.0000000000001030 |pmid=29420423 |s2cid=4198610 |type=Professional society guidelines}}</ref><ref name="Perera2012">{{cite journal |last1=Perera |first1=Nirmal |last2=Liolitsa |first2=Danae |last3=Iype |first3=Satheesh |last4=Croxford |first4=Anna |last5=Yassin |first5=Muhammed |last6=Lang |first6=Peter |last7=Ukaegbu |first7=Obioha |last8=van Issum |first8=Christopher |title=Phlebotonics for haemorrhoids |journal=Cochrane Database of Systematic Reviews |issue=8 |article-number=CD004322 |date=15 August 2012 |doi=10.1002/14651858.CD004322.pub3 |pmid=22895941|s2cid=28445593 |pmc=11930390 }}</ref><ref>{{cite journal |last1=Higuero |first1=T |last2=Abramowitz |first2=L |last3=Castinel |first3=A |last4=Fathallah |first4=N |last5=Hemery |first5=P |last6=Laclotte Duhoux |first6=C |last7=Pigot |first7=F |last8=Pillant-Le Moult |first8=H |last9=Senéjoux |first9=A |last10=Siproudhis |first10=L |last11=Staumont |first11=G |last12=Suduca |first12=JM |last13=Vinson-Bonnet |first13=B |title=Guidelines for the treatment of hemorrhoids (short report). |journal=Journal of Visceral Surgery |date=June 2016 |volume=153 |issue=3 |pages=213–8 |doi=10.1016/j.jviscsurg.2016.03.004 |pmid=27209079 |type=Professional society guidelines|doi-access= }}</ref><ref>{{cite journal |last1=Trompetto |first1=M. |last2=Clerico |first2=G. |last3=Cocorullo |first3=G. F. |last4=Giordano |first4=P. |last5=Marino |first5=F. |last6=Martellucci |first6=J. |last7=Milito |first7=G. |last8=Mistrangelo |first8=M. |last9=Ratto |first9=C. |title=Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement |journal=Techniques in Coloproctology |date=24 September 2015 |volume=19 |issue=10 |pages=567–575 |doi=10.1007/s10151-015-1371-9|pmid=26403234 |hdl=10447/208054 |s2cid=30827065 |hdl-access=free }}</ref>
===Procedures=== A number of office-based procedures may be performed. While generally safe, rare serious side effects such as [[sepsis|perianal sepsis]] may occur.<ref name=NG2011 /> Office based procedures are associated with less pain and less risk of complications than surgical hemorrhoidectomy.<ref name="Ashburn 2025" />
# '''[[Rubber band ligation]]''' is typically recommended as the first-line treatment in those with '''grade I to III disease'''.<ref name="NG2011" /> It is a procedure in which elastic bands are applied onto internal hemorrhoid at least 1 cm above the pectinate line to cut off its blood supply.<!-- <ref name=Review09 /> --> Within 5–7 days, the withered hemorrhoid falls off. Scarring at the site is intended to prevent re-engorgement of the hemorrhoids.<ref name="Ashburn 2025" /><!-- <ref name=Review09 /> --> If the band is placed too close to the pectinate line, intense pain results immediately afterwards.<ref name="Review09" /> The cure rate has been found to be about 87%, with a complication rate of up to 3% and the recurrence rate at 2 years was 15.5%.<ref name="NG2011" /><ref name="Review09" /><ref name="Ashburn 2025" /> # '''[[Sclerotherapy]]''' involves the injection of a [[sclerosing]] agent, such as [[phenol]], into the hemorrhoid. This causes the vein walls to collapse and the hemorrhoids to shrivel up. The success rate four years after treatment is about 70%.<ref name="Review09" /> This modality is less effective for bleeding symptoms or prolapse as compared to rubber band ligation, but it is associated with less post-procedure pain.<ref name="Ashburn 2025" /> # A number of '''[[cauterization]]''' methods have been shown to be effective for hemorrhoids, but are usually used only when other methods fail. This procedure can be done using [[electrocautery]], [[infrared radiation]], [[laser surgery]],<ref name="Review09" /> or [[cryosurgery]].<ref>{{cite journal |last = Misra |first = MC |author2 = Imlitemsu |title = Drug treatment of haemorrhoids |journal = Drugs |year = 2005 |volume = 65 |issue = 11 |pages = 1481–91 |pmid = 16134260 |doi = 10.2165/00003495-200565110-00003 |s2cid = 33128093 }}</ref> Infrared cauterization may be an option for '''grade I or II disease'''.<ref name="NG2011" /> In those with '''grade III or IV disease''', reoccurrence rates are high.<ref name="NG2011" /> About 30% of patients who underwent cauterization needed additional interventions for relief of hemorrhoidal disease.<ref name="Ashburn 2025" />
[[Hemorrhoidal artery embolization|Hemorrhoidal artery embolization (HAE)]] is a minimally invasive procedure performed by an [[Interventional radiology|interventional radiologist]].<ref name=":0">{{Cite web |title=Hemorrhoidal Artery Embolization (HAE) |url=https://www.uclahealth.org/medical-services/radiology/interventional-radiology/HAE |access-date=2024-07-18 |website=www.uclahealth.org |language=en}}</ref> HAE involves the blockage of abnormal blood flow to the rectal (hemorrhoidal) arteries using microcoils and/or [[microparticle]]s to decrease the size of the hemorrhoids and improve hemorrhoid related symptoms, especially bleeding.<ref name=":1">{{Cite AV media |url=https://www.youtube.com/watch?v=Whje31Jlm10 |title=Hemorrhoidal Artery Embolization Minimally Invasive Treatment for Symptomatic Internal Hemorrhoids |date=2024-06-24 |last=UCLA Health |access-date=2024-07-18 |via=YouTube}}</ref> HAE is very effective at stopping bleeding related symptoms with success rate of approximately 90%.<ref name=":3">{{Cite journal |last1=Makris |first1=Gregory C. |last2=Thulasidasan |first2=Narayan |last3=Malietzis |first3=George |last4=Kontovounisios |first4=Christos |last5=Saibudeen |first5=Affan |last6=Uberoi |first6=Raman |last7=Diamantopoulos |first7=Athanasios |last8=Sapoval |first8=Marc |last9=Vidal |first9=Vincent |date=January 2021 |title=Catheter-Directed Hemorrhoidal Dearterialization Technique for the Management of Hemorrhoids: A Meta-Analysis of the Clinical Evidence |journal=Journal of Vascular and Interventional Radiology |volume=32 |issue=8 |pages=1119–1127 |doi=10.1016/j.jvir.2021.03.548 |pmid=33971251 |issn=1051-0443}}</ref> Overall, the effectiveness of HAE is comparable to or better than surgery or transanal procedures.<ref name=":4">{{Cite web |title=Hemorrhoidal artery embolization a nonsurgical approach to internal hemorrhoids treatment {{!}} UCLA Health |url=https://www.uclahealth.org/news/article/hemorrhoidal-artery-embolization-novel-approach-internal |access-date=2025-07-20 |website=www.uclahealth.org |language=en}}</ref> The frequency and severity of any potential adverse events are also significantly lower in HAE compared to surgery or transanal procedures.<ref name=":4" />
===Surgery=== A number of surgical techniques may be used if conservative management and office based procedures fail.<ref name=NG2011 /> All surgical treatments are associated with some degree of complications, including bleeding, infection, [[anal stricture]]s, and [[urinary retention]], due to the close proximity of the rectum to the nerves that supply the bladder.<ref name=Review09 /> Also, a small risk of [[fecal incontinence]] occurs, particularly of liquid,<ref name=Beck2011 /><ref name="Pescatori 2008">{{cite journal |last = Pescatori |first = M |author2 = Gagliardi, G |title = Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures |journal = Techniques in Coloproctology |date = March 2008 |volume = 12 |issue = 1 |pages = 7–19 |pmid = 18512007 |doi = 10.1007/s10151-008-0391-0 |pmc = 2778725 }}</ref> with rates reported between 0% and 28%.<ref>{{cite journal |last = Ommer |first = A |author2 = Wenger, FA |author3 = Rolfs, T |author4 = Walz, MK |title = Continence disorders after anal surgery—a relevant problem? |journal = International Journal of Colorectal Disease |date = November 2008 |volume = 23 |issue = 11 |pages = 1023–31 |pmid = 18629515 |doi = 10.1007/s00384-008-0524-y |s2cid = 7247471 }}</ref> Mucosal [[ectropion]] is another condition which may occur after hemorrhoidectomy (often together with anal stenosis).<ref name=Garcia2002>{{cite journal |last = Lagares-Garcia |first = JA |author2 = Nogueras, JJ |title = Anal stenosis and mucosal ectropion |journal = The Surgical Clinics of North America |date = December 2002 |volume = 82 |issue = 6 |pages = 1225–31, vii |pmid = 12516850 |doi = 10.1016/s0039-6109(02)00081-6 }}</ref> This is where the anal mucosa becomes everted from the anus, similar to a very mild form of [[rectal prolapse]].<ref name=Garcia2002 /> # '''Excisional hemorrhoidectomy''' is a surgical excision of the hemorrhoid primarily indicated in grade 3-4 internal hemorrhoids or mixed disease that is not responsive to conservative and less invasive treatments.<ref name="Ashburn 2025" /> It is associated with significant postoperative pain and usually requires two to four weeks for recovery.<ref name="Review09" /> However, the long-term benefit is greater in those with '''grade III hemorrhoids''' as compared to rubber band ligation.<ref>{{cite journal |last = Shanmugam |first = V |author2 = Thaha, MA |author3 = Rabindranath, KS |author4 = Campbell, KL |author5 = Steele, RJ |author6 = Loudon, MA |title = Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids |journal = Cochrane Database of Systematic Reviews |date = Jul 20, 2005 |volume = 2011 |issue = 3 |article-number = CD005034 |pmid = 16034963 |doi = 10.1002/14651858.CD005034.pub2 |pmc = 8860341 }}</ref> It is the recommended treatment in those with a [[perianal hematoma|thrombosed external hemorrhoid]] if carried out within 24–72 hours.<ref name="NG2011" /><ref name="Day2006">{{cite book |last = Dayton |first = Peter F. Lawrence, Richard Bell, Merril T. |title = Essentials of general surgery |year = 2006 |publisher = Williams & Wilkins |location = Philadelphia; Baltimore |isbn = 978-0-7817-5003-5 |page = 329 |url = https://books.google.com/books?id=QOeHP5Ky610C&pg=PA329 |edition = 4th |url-status = live |archive-url = https://web.archive.org/web/20170908184817/https://books.google.com/books?id=QOeHP5Ky610C&pg=PA329 |archive-date = 2017-09-08 }}</ref> Evidence to support this is weak, however.<ref name="Dav2018" /> [[Glyceryl trinitrate (pharmacology)|Glyceryl trinitrate]] ointment after the procedure helps both with pain and with healing.<ref>{{cite journal |last = Ratnasingham |first = K |author2 = Uzzaman, M |author3 = Andreani, SM |author4 = Light, D |author5 = Patel, B |title = Meta-analysis of the use of glyceryl trinitrate ointment after haemorrhoidectomy as an analgesic and in promoting wound healing |journal = International Journal of Surgery |year = 2010 |volume = 8 |issue = 8 |pages = 606–11 |pmid = 20691294 |doi = 10.1016/j.ijsu.2010.04.012 |doi-access = free }}</ref> Excisional hemorrhoidectomy is the preferred method of surgical hemorrhoid removal.<ref name="Ashburn 2025"/> Open excisional hemorrhoidectomy (leaving the surgical excision site to heal on its own) and closed excisions (suturing the site of hemorrhoidectomy closed) have similar outcomes with regards to complications and relapse rates.<ref name="Ashburn 2025"/> Hemorrhoid recurrence rates are about 6.5% at 2 years. Common complications in the post-surgery period include urinary retention, fecal incontinence (due to swelling and inflammation affecting the anal sphincter after surgery), bleeding, and pain. The risk of these complications is 3-6%, however fecal incontinence may be permanent in rare cases.<ref name="Ashburn 2025"/> # '''Doppler-guided [[transanal hemorrhoidal dearterialization]]''' is a minimally invasive treatment using an ultrasound Doppler to accurately locate the arterial blood inflow. These arteries are then "tied off" and the prolapsed tissue is sutured back to its normal position. It has a slightly higher recurrence rate but fewer complications compared to a hemorrhoidectomy.<ref name="Review09" /> # '''Stapled hemorrhoidectomy''', also known as '''[[stapled hemorrhoidopexy]]''', involves the removal of much of the abnormally enlarged hemorrhoidal tissue, followed by a repositioning of the remaining hemorrhoidal tissue back to its normal anatomical position. It is generally less painful and is associated with faster healing compared to complete removal of hemorrhoids.<ref name="Review09" /> However, the chance of symptomatic hemorrhoids returning is greater than for conventional hemorrhoidectomy,<ref name="Jaya2006">{{cite journal |last = Jayaraman |first = S |author2 = Colquhoun, PH |author3 = Malthaner, RA |title = Stapled versus conventional surgery for hemorrhoids |journal = Cochrane Database of Systematic Reviews |date = Oct 18, 2006 |volume = 2010 |issue = 4 |article-number = CD005393 |pmid = 17054255 |doi = 10.1002/14651858.CD005393.pub2 |pmc = 8887551 }}</ref> so it is typically recommended only for '''grade II or III disease'''.<ref name="NG2011" />
==Epidemiology== It is difficult to determine how common hemorrhoids are as many people with the condition do not see a healthcare provider.<ref name=AFP2006 /><ref name=CE2009>{{cite journal |last = Reese |first = GE |author2 = von Roon, AC |author3 = Tekkis, PP |title = Haemorrhoids. |journal = Clinical Evidence |date = Jan 29, 2009 |volume = 2009 |pmid = 19445775 |pmc = 2907769 }}</ref> However, symptomatic hemorrhoids are thought to affect at least 50% of the US population at some time during their lives, and around 5% of the population is affected at any given time.<ref name=Review09 /> Both sexes experience about the same incidence of the condition,<ref name=Review09 /> with rates peaking between 45 and 65 years.<ref name=Kaidar2007 /> Some studies have found that they are common in people of higher [[socioeconomic status]],<ref name=Beck2011 /> however this may reflect differences in healthcare access rather than true prevalence.<ref name="p663">{{cite journal | last=Lohsiriwat | first=Varut | title=Hemorrhoids: From basic pathophysiology to clinical management | journal=World Journal of Gastroenterology | volume=18 | issue=17 | date=2012 | pages=2009–2017 | pmid=22563187 | doi=10.3748/wjg.v18.i17.2009 | doi-access=free | pmc=3342598 }}</ref>
Long-term outcomes are generally good, though some people may have recurrent symptomatic episodes.<ref name=AFP2006 /> Only a small proportion of persons end up needing surgery.<ref name=Beck2011 />
==History== [[File:11th century English surgery.jpg|thumb|upright|An 11th-century English miniature. On the right is an operation to remove hemorrhoids.]]
The first known mention of this disease is from a 1700 BC Egyptian [[papyrus]], which advises: "Thou shouldest give a recipe, an ointment of great protection; [[acacia]] leaves, ground, titurated and cooked together. Smear a strip of fine linen there-with and place in the anus, that he recovers immediately."<ref name="Charles2002(book)" /> In 460 BC, the [[Hippocratic corpus]] discusses a treatment similar to modern rubber band ligation: "And hemorrhoids in like manner you may treat by transfixing them with a needle and tying them with very thick and woolen thread, for application, and do not foment until they drop off, and always leave one behind; and when the patient recovers, let him be put on a course of [[Hellebore]]."<ref name="Charles2002(book)" /> Hemorrhoids may have been described in the [[Bible]], with earlier English translations using the now-obsolete spelling "[[emerods]]".<ref name=Kaidar2007 />
[[Aulus Cornelius Celsus|Celsus]] (25 BC – 14 AD) described ligation and excision procedures and discussed the possible complications.<ref name="Agbo 2011" /> [[Galen]] advocated severing the connection of the arteries to veins, claiming it reduced both pain and the spread of gangrene.<ref name="Agbo 2011">{{cite journal |last = Agbo |first = Indru Khubchandani |title = Surgical management of hemorrhoids |journal = Journal of Surgical Technique and Case Report |date = 1 January 2011 |volume = 3 |issue = 2 |pages = 68–75 |doi = 10.4103/2006-8808.92797 |pmid = 22413048 |pmc = 3296437 |doi-access = free }}</ref> The [[Susruta Samhita]] (4th–5th century BC) is similar to the words of Hippocrates, but emphasizes wound cleanliness.<ref name="Charles2002(book)" /> In the 12th century, the Jewish physician and philosopher [[Maimonides]] also composed a treatise on hemorrhoids titled ''Fī al-Bawāsīr'', part of his series of medical writings.<ref name=":33">{{Citation |last=Ferrario |first=Gabriele |title=Science and Medicine |date=2021 |work=The Cambridge History of Judaism: Volume 5: Jews in the Medieval Islamic World |volume=5 |page=849 |editor-last=Lieberman |editor-first=Phillip I. |url=https://www.cambridge.org/core/books/cambridge-history-of-judaism/science-and-medicine/AC6F034D01994F6501EA22A2B0558C76 |access-date=2025-07-14 |series=The Cambridge History of Judaism |place=Cambridge |publisher=Cambridge University Press |isbn=978-0-521-51717-1 |last2=Kozodoy |first2=Maud}}</ref> In the 13th century, European surgeons such as [[Lanfranc of Milan]], [[Guy de Chauliac]], [[Henri de Mondeville]], and John of Ardene made great progress and development of the surgical techniques.<ref name="Agbo 2011" />
In medieval times, hemorrhoids were also known as [[Saint Fiacre]]'s curse after a sixth-century saint who developed them following tilling the soil.<ref name=ascr1>{{Cite web |first = Peter |last = Cataldo |title = Hemorrhoids |publisher = American Society of Colon and Rectal Surgeons |location = Arlington Heights, IL |url = http://www.fascrs.org/physicians/education/core_subjects/2005/hemorrhoids/ |year = 2005 |access-date = 30 September 2013 |archive-url = https://web.archive.org/web/20131203055121/http://www.fascrs.org/physicians/education/core_subjects/2005/hemorrhoids/ |archive-date = 3 December 2013 }}</ref> The first use of the word ''hemorrhoid'' in English occurs in 1398, derived from the [[Old French]] {{Lang|fro|emorroides}}, from [[Latin]] {{Lang|la|hæmorrhoida}},<ref>[https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0059%3Aentry%3Dhaemorrhoida hæmorrhoida] {{webarchive|url=https://web.archive.org/web/20110225135402/http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0059%3Aentry%3Dhaemorrhoida |date=2011-02-25 }}, Charlton T. Lewis, Charles Short, ''A Latin Dictionary'', on Perseus Digital Library</ref> in turn from the Greek {{Lang|grc|αἱμορροΐς}} ({{Lang|grc-latn|haimorrhois}}), {{Gloss|liable to discharge blood}}, from {{Lang|grc|αἷμα}} ({{Lang|grc-latn|haima}}), {{Gloss|blood}}<ref>[https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dai%28%3Dma αἷμα] {{webarchive|url=https://web.archive.org/web/20110605030523/http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dai%28%3Dma |date=2011-06-05 }}, Henry George Liddell, Robert Scott, ''A Greek-English Lexicon'', on Perseus Digital Library</ref> and {{Lang|grc|ῥόος}} ({{Lang|grc-latn|rhoos}}), {{Gloss|stream, flow, current}},<ref>[https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dr%28o%2Fos ῥόος] {{webarchive|url=https://web.archive.org/web/20110605023332/http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dr%28o%2Fos |date=2011-06-05 }}, Henry George Liddell, Robert Scott, ''A Greek-English Lexicon'', on Perseus Digital Library</ref> itself from {{Lang|grc|ῥέω}} ({{Lang|grc-latn|rheo}}), {{Gloss|to flow, to stream}}.<ref>[https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dr%28e%2Fw ῥέω] {{webarchive|url=https://web.archive.org/web/20110605023328/http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dr%28e%2Fw |date=2011-06-05 }}, Henry George Liddell, Robert Scott, ''A Greek-English Lexicon'', on Perseus Digital Library</ref>
==Notable cases== * Hall-of-Fame baseball player [[George Brett (baseball)|George Brett]] was removed from a game in the [[1980 World Series]] due to hemorrhoid pain. After undergoing minor surgery, Brett returned to play in the next game, quipping, "My problems are all behind me".<ref>{{cite news |url = http://mlb.mlb.com/news/article.jsp?ymd=20090305&content_id=3921596 |work = Major League Baseball |title = Memories fill Kauffman Stadium |author = Dick Kaegel |date = March 5, 2009 |url-status = live |archive-url = https://web.archive.org/web/20110605011124/http://mlb.mlb.com/news/article.jsp?ymd=20090305&content_id=3921596 |archive-date = June 5, 2011 }}</ref> Brett underwent further hemorrhoid surgery the following spring.<ref>{{cite news |url = https://query.nytimes.com/gst/fullpage.html?res=9D0DE2DC1439F932A35750C0A967948260 |work = The New York Times |title = Brett in Hospital for Surgery |date = March 1, 1981 |agency = Associated Press |url-status = live |archive-url = https://web.archive.org/web/20090211025738/http://query.nytimes.com/gst/fullpage.html?res=9D0DE2DC1439F932A35750C0A967948260 |archive-date = February 11, 2009 }}</ref> * Conservative political commentator [[Glenn Beck]] underwent surgery for hemorrhoids, subsequently describing his unpleasant experience in a widely viewed 2008 [[YouTube]] video.<ref>{{cite news |title = Glenn Beck: Put the 'Care' Back in Health Care |url = https://abcnews.go.com/GMA/PainManagement/story?id=4101741&page=1 |access-date = 17 September 2012 |newspaper = ABC Good Morning America |date = Jan 8, 2008 |url-status = live |archive-url = https://web.archive.org/web/20121128053313/https://abcnews.go.com/GMA/PainManagement/story?id=4101741&page=1 |archive-date = 28 November 2012 }}</ref><ref>{{cite web |url = https://www.youtube.com/watch?v=bX1rLv_hNeI |title = Beck From the Dead |type = Mr·Beck speaking from home shortly after hospital |work = [[YouTube]] |date = 3 January 2008 |publisher = GlennBeckVideos |url-status = live |archive-url = https://web.archive.org/web/20160309123422/https://www.youtube.com/watch?v=bX1rLv_hNeI |archive-date = 2016-03-09 }}</ref> * Former U.S. President [[Jimmy Carter]] had surgery for hemorrhoids in 1984.<ref>{{cite news |url = https://www.nytimes.com/1984/01/19/us/carter-leaves-hospital.html |title = Carter Leaves Hospital |date = January 19, 1984 |work = The New York Times |access-date = 12 September 2013 |url-status = live |archive-url = https://web.archive.org/web/20140309123504/http://www.nytimes.com/1984/01/19/us/carter-leaves-hospital.html |archive-date = 9 March 2014 }}</ref> * Cricketers [[Matthew Hayden]] and [[Viv Richards]] have suffered the condition.<ref>{{cite web |title = The Five: Wounded pride |url = https://www.smh.com.au/sport/cricket/the-five-wounded-pride-20091212-kpoy.html |website = The Sydney Morning Herald |access-date = 24 April 2016 |url-status = live |archive-url = https://web.archive.org/web/20170203134951/http://www.smh.com.au/sport/cricket/the-five-wounded-pride-20091212-kpoy.html |archive-date = 3 February 2017 |date = 2009-12-12 }}</ref> *During World War II, US Army Lieutenant Colonel [[Harold Cohen (soldier)|Harold Cohen]] was selected by General [[George S. Patton]] to organize a raid to rescue Patton's son-in-law from a German prison camp; Cohen was prevented from leading the raid due to hemorrhoids.<ref name=":2">{{Cite journal | date = 1997 | title = Harold Cohen | url = http://www.omsa.org/files/jomsa_arch/Splits/1997/220237_JOMSA_Vol48_3_10.pdf | journal = Journal of the Orders and Medals Society of America | volume = 48 | issue = 3 | page = 10}}</ref> Patton personally examined Cohen and remarked, "that is some sorry ass".<ref>{{cite book | last1 = Baron | first1 = Richard | last2 = Baum | first2 = Abe | last3 = Goldhurst | first3 = Richard | title = Raid!: the untold story of Patton's secret mission | publisher = Putnam | year = 1981 | url = https://archive.org/details/raiduntoldstoryo00baro/mode/2up | page = 20 | isbn = 978-0-399-12597-3 }}</ref> {{Clear}}
==References== {{Reflist}}
==External links== {{Commons category|Hemorrhoids}} * {{cite journal|last1=Davis|first1=BR|last2=Lee-Kong|first2=SA|last3=Migaly|first3=J|last4=Feingold|first4=DL|last5=Steele|first5=SR|title=The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids.|journal=Diseases of the Colon and Rectum|date=March 2018|volume=61|issue=3|pages=284–292|doi=10.1097/DCR.0000000000001030|pmid=29420423|s2cid=4198610}}
{{Medical condition classification and resources | DiseasesDB = 10036 | ICD10 = {{ICD10|K64}} | ICD9 = {{ICD9|455}} | ICDO = | OMIM = | MedlinePlus = 000292 | eMedicineSubj = med | eMedicineTopic = 2821 | eMedicine_mult = {{eMedicine2|emerg|242}} | MeshID = D006484 }} {{Vascular diseases}} {{Authority control}}
[[Category:Diseases of veins, lymphatic vessels and lymph nodes]] [[Category:Digestive diseases]] [[Category:Medical conditions related to obesity]] [[Category:Colorectal surgery]] [[Category:Rectum]] [[Category:Anus]] [[Category:Wikipedia medicine articles ready to translate (full)]] [[Category:Acute pain]] [[Category:Wikipedia emergency medicine articles ready to translate]] [[Category:Anal diseases]]