![]() ![]() Patients usually have a combination of both types only a minority of patients has only one type. To promote better understanding of hemorrhoidal disease, the Coloproctology Unit of the Gastroenterology Department, Hospital General de México, classifies hemorrhoids as internal or external. Therefore, alcohol, spicy foods, constipation, diarrhea, pregnancy, occupation, sedentary life style, and possibly other factors should be considered as predisposing, not as etiologic, factors. However, it is important to note that not all patients with hemorrhoidal disease are constipated. With constant straining, the supports of these cushions become distended and cause hemorrhoidal prolapse below the anorectal junction and outside the anal canal. The most consistent of these is constipation: with greater effort made during evacuation, congestion occurs in the anal cushions. In general, it has not been possible to identify a particular cause that triggers the condition, and it is commonly accepted that certain factors can play a role in the process in a given patient. For many years, it was thought that hemorrhoids were made up of dilations in blood vessels of the upper and lower hemorrhoidal plexus, but the real explanation may not be so simple. The etiology of hemorrhoids has never been proven. Rare before the age of 20 years, hemorrhoidal symptom frequency increases with age probably 50% of adults 50 years or older have experienced hemorrhoidal symptoms at some time in their lives. 2 It is difficult to have an exact measure of the prevalence of this disease, but we can state with confidence that in Mexico at least 5% of the general population have hemorrhoid-related symptoms. The term “hemorrhoids” comes from the Greek word “haimorrhoides”, which means: haima(blood or bleeding) and rhoos(flow). Maimonides (1235–1305 AD) in his Treatise on Hemorrhoids noted the importance of diet and detailed a number of treatments to alleviate hemorrhoidal symptoms, including “fatty chicken broth.” He also recommended medicines to be applied as suppositories, creams, or enemas to eliminate or prevent symptoms. Galen (131–201 AD) in De Medicina described hemorrhoid ligation and extirpation of hemorrhoids, as well as their complications. Hippocrates (460–377 BC) in the Hippocratic Corpus made reference to hemorrhoids and proposed medical and surgical treatments. Hemorrhoidal disease has been one of the most common human ailments. ![]()
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