Types of hemorrhoids

Since no one method of treatment is suitable for all types, of hemorrhoids, it is necessary to have a classification.

Anatomically, two distinct varieties are recognized; external and internal hemorrhoids, depending upon whether they are located externally or internally to the external sphincter ani muscle.

The external hemorrhoids implicate the superior hemorrhoidal veins.

Internal hemorrhoids implicate the superior hemorrhoidal veins. Frequently the two varieties co-exist in the same patient and are often labelled as externointernal, combined, or mixed hemorrhoids.

The pathology of the two varieties is different; each variety may occur as a separate condition in the same patient, but more often when both varieties occur in the same patient they are combined
or associated together.

It is an anatomic fact that there is a definite communication between the inferior hemorrhoidal veins below, and the superior hemorrhoidal veins above, through the circular veins which extend around the anal canal and any condition that causes dilatation of one set of these veins, necessarily must through their communications, be felt in the other set.

From a standpoint of selection and discussion of treatment, it would appear more advantageous to cosnider anatomicall, only two varieties. The external and the internal, as the treatment depends entirely upon whether the hemorrhoid is external or internal to the external sphincter ani.

External hemorrhoids may be further classidied clinically and pathologically.

Classification of external hemorrhoids

1. Clinically
A simple dilitation of the veins surrounding the anal orifice.

2. Pathologically

2.1 Thrombosed
2.2 Ruptured
2.3 Connective Tissue (commonly referred to as dog ear, sentinel or skin tabs)
2.4 Inflamed

The connective tissue type, strictly speaking, is not a hemorrhoid, but common use has placed it in the arrangement.

Internal hemorrhoids may also be further classified clinically and pathologically.

Classification of internal hemorrhoids

1. Clinically
1.1 According to the degree of the protruding parts as First, Second and Third degrees
1.2 Irreducible

2. Pathologically
2.1 Strangulated
2.2 Thrombosed
2.3 Gangrenous
2.4 Inflamed