Gut Instincts: A Clinician's Handbook of Digestive and Liver Diseases

Eric Esrailian, MD, MPH

Chapter 29: Hemorrhoids (continued)

Jonathan Sack, MD

Hemorrhoids are a normal anatomic structure that commonly become pathologically enlarged and produce a variety of symptoms. Due to a variety of stresses, including upright posture and an omnivorous diet, the 3 hemorrhoidal sinusoidal tufts (left lateral, right anterior, and right posterior) become dilated due to arteriovenous malformations producing engorgement with resultant redundancy of the overlying mucosa. These sagging internal hemorrhoids can prolapse into or through the anal canal and become symptomatic. Prolapsing internal hemorrhoids can cause anal leakage by preventing closure of…