Hemorrhoids are normal vascular structures in the anal canal that are made from a plexus of veins that surround the anus and lower rectum and drain into the upper and lower hemorrhoidal veins. Although present, they are rarely form dilated and symptomatic hemorrhoids in childhood.


They present as painless lower gastrointestinal bleeding during defecation, whilst they can also cause pain in cases of thrombosis within the hemorrhoid. Hemorrhoids are diagnosed by clinical examination and are divided into grades:

  • 1st degree: appear only on proctoscopy and do not protrude from the anus
  • 2nd degree that project from the anus but reduce spontaneously
  • 3rd degree require manual reduction and
  • 4th degree that are not reducible and protrude permanently from the anus.

Predisposing factors include age, bowel disorders (constipation) and diseases that enlarge the hemorrhoidal plexus, such as pelvic tumors, portal hypertension.


The therapeutic approach depends on the degree (severity). It is usually conservative and consists of the treatment of constipation, which usually consists of diet and lifestyle modifications and pain relief with water baths and topical use of healing creams. In case of hemorrhoidal thrombosis, the treatment is surgical and consists of incision and removing of the thrombus.