Fast Five Quiz: Hemorrhoid Diagnosis and Treatment

Praveen K. Roy, MD


March 07, 2019

Risk factors historically associated with the development of hemorrhoids include the following:

  • Decreased venous return

  • Straining and constipation

  • Pregnancy

  • Lack of erect posture

  • Familial tendency

  • Higher socioeconomic status

  • Chronic diarrhea

  • Colon cancer

  • Hepatic disease

  • Obesity

  • Elevated anal resting pressure

  • Spinal cord injury

  • Loss of rectal muscle tone

  • Rectal surgery

  • Episiotomy

  • Anal intercourse

  • Inflammatory bowel disease, including ulcerative colitis, and Crohn disease

External hemorrhoids occur more commonly in young and middle-aged adults than in older adults. The prevalence of hemorrhoids increases with age, with a peak in persons aged 45-65 years. Patients presenting with hemorrhoidal disease are more frequently white, of higher socioeconomic status, and from rural areas. Hemorrhoids have no known sex predilection, although men are more likely to seek treatment. However, pregnancy causes physiologic changes that predispose women to developing symptomatic hemorrhoids. As the gravid uterus expands, it compresses the inferior vena cava, causing decreased venous return and distal engorgement.

Internal hemorrhoids cannot cause cutaneous pain, because they are above the dentate line and are not innervated by cutaneous nerves. However, they can bleed; prolapse; and, as a result of the deposition of an irritant onto the sensitive perianal skin, cause perianal itching and irritation. 

Read more on the etiology and epidemiology of hemorrhoids.


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