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Hemorrhoid or hemorrhoids, refers to a condition where there is a presence of masses of dilated blood vessel underneath the lining of the skin in the anal canal or rectum. Studies have documented that the inflamed mass is actually composed of spongy vascular tissue with several direct arteriovenous connections. Hippocrates coined the term hemorrhoids from the Greek words hema meaning blood and rhoos meaning flowing.

Men and women alike can have hemorrhoids; these are extremely common occurrences and in fact more than 50% of the population has them by the time they reach 50 years of age. Hemorrhoids have traditionally been thought of as varicose veins of the anus or rectum, or as “varicosities” of hemorrhoidal tissue.

All through history, hemorrhoids have plagued humankind, possibly beginning when we first learned how to be in upright position. During the Middle times, hemorrhoids were identified as St. Fiacre’s curse (St Fiacre, patron saint of gardeners, contracted a terrible case of prolapsed hemorrhoids after a day of toiling his garden).

There are usually two classifications of hemorrhoids namely internal and external hemorrhoids. The internal hemorrhoids are those that take place above the anal sphincter and those that take place below the anal sphincter are coined as external hemorrhoids. A single person can suffer from both forms at the same time. Though typically, hemorrhoids are considered chronic health problems, they may trigger acute episodes.

Internal hemorrhoids are found within the left lateral, right anterior, and right posterior positions inside the anal canal. Usually, hemorrhoidal positions are consistent within the anus. In general, internal hemorrhoids are not painful and most people don’t even know they have them, since the area doesn’t have pain receptors. If they become irritated, they may bleed, however. They should be detected and treated at once, or you can get strangulated or prolapsed hemorrhoids.

The second form, external hemorrhoids, occurs outside the anal verge. Occasionally, it is painful, and can be experienced with swelling and irritation. Although itching occurs, it is not a symptom of hemorrhoid but is usually due to skin irritation. If the dilated vein ruptures and/or develops a blood clot, it will be termed as thrombosed hemorrhoid (most often occurs on external hemorrhoids).

The classification of hemorrhoids is by history and not by means of physical examination. The grading is as follows: Grade I - bleeding without prolapsed; Grade II - prolapse with spontaneous reduction; Grade III - prolapse with manual reduction; Grade IV - irreducible prolapse. This classification has been adopted for many years and associates relatively well with treatment algorithms. Often, Grade I and II hemorrhoids are effectively treated by non-operative methods while Grade III and Grade IV hemorrhoids are likely to necessitate surgery.

For most women on their first pregnancy, they experience hemorrhoids during the last trimester. Suggested potential causes are impediment of venous return by the gravid uterus, hormonal changes and chronic straining. Although the real etiology is unknown, once the woman has given birth, the majority of hemorrhoidal symptoms subside. In unusual cases, a surgery called hemorrhoidectomy may possibly be necessary and can be performed with minimum morbidity and little threat to the fetus.