[4] While the exact cause of hemorrhoids remains unknown, a number of factors that increase pressure in the abdomen are believed to be involved.

[9] Initial measures consist of increasing fiber intake, drinking fluids to maintain hydration, NSAIDs to help with pain, and rest.

[6] Hemorrhoidal artery embolization (HAE) is a safe and effective minimally invasive procedure that can be performed and is typically better tolerated than traditional therapies.

[1] Hemorrhoids affect people most often between 45 and 65 years of age,[5] and they are more common among the wealthy,[4] although this may reflect differences in healthcare access rather than true prevalence.

[8] If hemorrhoids are large and cause issues with hygiene, they may produce irritation of the surrounding skin, and thus itchiness around the anus.

[16] Internal hemorrhoids usually present with painless, bright red rectal bleeding during or following a bowel movement.

[8] Other symptoms may include mucous discharge, a perianal mass if they prolapse through the anus, itchiness, and fecal incontinence.

[18] A number of factors are believed to play a role, including irregular bowel habits (constipation or diarrhea), lack of exercise, nutritional factors (low-fiber diets), increased intra-abdominal pressure (prolonged straining, ascites, an intra-abdominal mass, or pregnancy), genetics, an absence of valves within the hemorrhoidal veins, and aging.

[1][5] Other factors believed to increase risk include obesity, prolonged sitting,[8][dubious – discuss] a chronic cough, and pelvic floor dysfunction.

[1] Hemorrhoid cushions are a part of normal human anatomy and become a pathological disease only when they experience abnormal changes.

[5] They are composed of neither arteries nor veins, but blood vessels called sinusoids, connective tissue, and smooth muscle.

[8] When a person bears down, the intra-abdominal pressure grows, and hemorrhoid cushions increase in size, helping maintain anal closure.

[5] Hemorrhoid symptoms are believed to result when these vascular structures slide downwards or when venous pressure is excessively increased.

[8] Visual confirmation of internal hemorrhoids, on the other hand, may require anoscopy, insertion of a hollow tube device with a light attached at one end.

[2] They were classified in 1985 into four grades based on the degree of prolapse:[1][2] External hemorrhoids occur below the dentate (or pectinate) line.

[2] Many anorectal problems, including fissures, fistulae, abscesses, colorectal cancer, rectal varices, and itching have similar symptoms and may be incorrectly referred to as hemorrhoids.

Conservative treatment typically consists of foods rich in dietary fiber, intake of oral fluids to maintain hydration, nonsteroidal anti-inflammatory drugs, sitz baths, and rest.

[2] These may include a barrier cream such as petroleum jelly or zinc oxide, an analgesic agent such as lidocaine, and a vasoconstrictor such as epinephrine.

[6] Hemorrhoidal artery embolization (HAE) is an additional minimally invasive procedure performed by an interventional radiologist.

[6] All surgical treatments are associated with some degree of complications, including bleeding, infection, anal strictures, and urinary retention, due to the close proximity of the rectum to the nerves that supply the bladder.

[5] Some studies have found that they are common in people of higher socioeconomic status,[2] however this may reflect differences in healthcare access rather than true prevalence.

[2] The first known mention of this disease is from a 1700 BC Egyptian papyrus, which advises: "Thou shouldest give a recipe, an ointment of great protection; acacia leaves, ground, titurated and cooked together.

"[14] In 460 BC, the Hippocratic corpus discusses a treatment similar to modern rubber band ligation: "And hemorrhoids in like manner you may treat by transfixing them with a needle and tying them with very thick and woolen thread, for application, and do not foment until they drop off, and always leave one behind; and when the patient recovers, let him be put on a course of Hellebore.

[48] Galen advocated severing the connection of the arteries to veins, claiming it reduced both pain and the spread of gangrene.

[49] The first use of the word "hemorrhoid" in English occurs in 1398, derived from the Old French "emorroides", from Latin hæmorrhoida,[50] in turn from the Greek αἱμορροΐς (haimorrhois), "liable to discharge blood", from αἷμα (haima), "blood"[51] and ῥόος (rhoos), "stream, flow, current",[52] itself from ῥέω (rheo), "to flow, to stream".