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Hemorrhoids, also known as piles, are swellings containing enlarged blood vessels that are found inside or around the rectum and anus. It can cause symptoms ranging from minimal discomfort or inconvenience to excruciating pain and significant psychosocial implications.It results from an increased pressure gradient within the hemorrhoids plexus due to increased intra-abdominal pressure while prolonged straining during defecation or during pregnancy and labor. It is one of the most common causes of rectal bleeding.Causes and Risk FactorsExact cause is unknown but certain risk factors are known to play a role, theseinclude - a family history of hemorrhoids, chronic diarrhea or constipation, sedentary lifestyle, obesity, lack of exercise, low fibre diet, increased intra-abdominal pressure, inflammatory bowel disease, high socioeconomic status, aging, etc.Signs and SymptomsIn about 40% cases of pathological hemorrhoids there are no significant symptoms. Typical symptoms associated with hemorrhoids are pain, bleeding, pruritus, burning and swelling. On examination, skin tags, fistula or fissure, prolapsed or thrombosed hemorrhoids and blood can be found.Internal hemorrhoids often result in painless, bright red rectal bleeding during or after defecation. Blood usually covers the stool, called hematochezia, is on the toilet paper or drips into the toilet bowl. Stool is normal coloured. There may be an associated mucous discharge, perianal mass, itchiness and fecal incontinence.External hemorrhoids, when thrombosed, often result in pain and swelling in the area of the anus which resolves in 2-3 days. It can also cause itching in the surrounding anal region.DiagnosisHemorrhoids are diagnosed with the help of a physical examination. External hemorrhoids occur below the dentate line. Internal hemorrhoids originate above the pectinate line and are classified into four grades on the basis of degree of prolapse.ManagementManagement focuses on avoiding constipation by an increased intake of dietary fibre, increased water intake, spending less time attempting to defecate, and more physical activity.