Hello and welcome to the Zero to Finals podcast. My name is Tom and in this episode I'm going to be talking to you about hemorrhoids.

And you can find written notes on this topic at zero to finals.com slash hemorrhoids or in the general surgery section of the zero to finals surgery book.

So let's get straight into it.

Hemorrhoids are enlarged anal vascular cushions.

It's not clear why they become enlarged and swollen, but they're often associated with constipation

and straining to open the bowels.

They're also more common with pregnancy, obesity, increased age and increased intra-abdominal

pressure, for example weightlifting or chronic coughing.

They often occur in pregnancy, most likely due to constipation, pressure from the baby in the pelvis and the effects

of the hormones that relax the connective tissues. Let's talk about the anal cushions. The anal

cushions are specialised submucosal tissue that contain connections between the arteries and the veins,

making them very vascular.

They are supported by smooth muscle and connective tissue.

They help to control anal continents along with the internal and external sphincters.

The blood supply is from the rectal arteries.

When we describe pathology at the anus is described as a clock face,

as though the patient was in a lithotomy position on their back with their legs raised.

12 o'clock is pointing towards the genitals and 6 o'clock is pointing towards the back.

The anal cushions are located at 3, 7 and 11 o'clock.

Let's talk about the classification. The classification of hemorrhoids depends on their size and whether they prolapse from the anus. First degree hemorrhoids have no prolapse. Second degree haemorrhoids prolapse when straining and they return inside the anus on relaxing.

Third degree haemorrhoids prolapse when straining do not return on relaxing but can be pushed back inside.

And fourth degree haemorrhoids are permanently prolapsed.

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