Hemorrhoids are a common gastrointestinal disorder characterized by pain, swelling, itching, tenderness, and bleeding. Although hemorrhoids are not life-threatening, individual patients often suffer painful symptoms that can limit social activities and have a negative impact on the quality of life.
In the United States, hemorrhoids affect nearly 5% of the population, with approximately 10 million patients annually reporting symptoms of hemorrhoidal disease. Approximately one-third visit a physician for evaluation and treatment of their hemorrhoids. More than half of the U.S. population will experience hemorrhoidal disease at least once in their life. For both men and women, a peak of prevalence occurs between 45 and 65 years of age.
Hemorrhoids are defined as internal or external according to their position relative to the dentate line. Classification is important for selecting the optimal treatment for an individual patient. Accordingly, physicians use the following grading system:
- Grade I: Hemorrhoids not prolapsed but bleeding.
- Grade II: Hemorrhoids prolapse and reduce spontaneously with or without bleeding.
- Grade III: Prolapsed hemorrhoids that require reduction manually.
- Grade IV: Prolapsed and cannot be reduced including both internal and external hemorrhoids that are confluent from skin tag to inner anal canal.