Hemorrhoids – Classification and Clinical Examination


Hemorrhoids (the ancient Greek (aimorrois), composed of (aima) “blood” and (reo) “drain”) are normal anatomic structures, which are responsible for protecting the anal canal, to help to maintain fecal continence and perform venous drainage of the region. We call hemorrhoids dilation of veins, with or without inflammation, hemorrhage or thrombosis of them.

It is estimated that the incidence of hemorrhoids in the general population is less than 5%. The main complaint related to hemorrhoids is that of bleeding occasionally, around the feces, blood “live” with the presence or absence of nipple observed on palpation. The presence of pain at defecation is more characteristic of fissure or abscess, but also can occur in hemorrhoidal disease if inflammation of venous thrombosis.


The increase in tension during bowel movements caused by diarrhea or constipation can lead to hemorrhoids. It is therefore a common condition due to constipation caused by water retention experiencing premenstrual syndrome or menstruation.

Hypertension, particularly portal hypertension, can also cause hemorrhoids because the connections between the portal vein and vena cava which occur in the rectal wall – known as portocaval anastomoses.

The obesity can be a factor in increased pressure rectal vein. Staying seated for long periods of time can cause hemorrhoids. A poor muscle tone or poor posture can result in too much pressure on the rectal veins and can also cause hemorrhoids.

Pregnancy can lead to hypertension and increased pressure during bowel movements, so hemorrhoids are also often associated with pregnancy.

The smoking during bowel movements can aggravate hemorrhoids can lead to serious internal bleeding from veins in the rectal area.

Excessive consumption of alcohol or caffeine can cause hemorrhoids. Both can cause diarrhea. Note that caffeine increases blood pressure temporarily, but not believed to cause chronic hypertension. Alcohol can also cause alcoholic liver disease leading to portal hypertension and hemorrhoids.


Hemorrhoids are classified in two ways: as the location (internal or external) and in the extent (1, 2, 3 and 4 degrees) in the case of internal.

In Grade I, the patient has an increase in the number and size of the haemorrhoid veins, but no prolapse.

In the Grade II, the hemorrhoid is present outside the anal canal at the time of evacuation, but return spontaneously to the inside of the anal canal.

In Grade III, there is also the prolapsed hemorrhoid, but it needs help manual for your return to the anal canal.

The Grade IV presents a prolapsed hemorrhoid permanent and irreducible, which brings more discomfort to the patient.

Clinical examination

Proctologic examination consists of three steps: inspection, digital rectal examination and divided into three groups. Anal inspection is the external observation of the anus, and this allows the viewing of external hemorrhoids, as well as the prolapsed internal hemorrhoids. Rectal examination is aimed at assessing the muscles of the anus called anal sphincter, and the evaluation of lesions of the anal canal. The anuscopy is an important test as it is introduced into (anoscope) into the anus to the observation of the internal anal canal, and is accomplished in seconds and without pain when proceeded by a registered doctor.

A colonoscopy (endoscopy of the large intestine) is not indicated for the evaluation of hemorrhoidal disease. However, in patients over 50 years and / or complaints of anal bleeding, especially in families with a history of colon cancer, colonoscopy should be performed, regardless of the diagnosis of hemorrhoids. The presence of hemorrhoids does not rule out the possibility of colon cancer, and that is why all people with anal bleeding should see a doctor, since this is the person capable of providing diagnosis and treatment.

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