1. Made by:
ohood abu hamad sabaa abu hijle

2. Hemorrhoids are enlarged veins in the anus or lower rectum.
Hemorrhoids are normal features of anatomy; the presence of hemorrhoids without accompanying symptoms (pain, pruritus, bleeding) does not necessitate treatment

3. Internal
Internal hemorrhoids usually present with painless, bright red, rectal bleeding during or following a bowel movement.The blood typically covers the stool
Other symptoms may include mucous discharge, a perianal mass if they prolapse through the anus, itchiness, and fecal incontinence.Internal hemorrhoids are usually only painful if they become thrombosed or necrotic.
 occur just inside the anus, at the beginning of the rectum.

4. External
If not thrombosed, external hemorrhoids may cause few problems. However, when thrombosed, hemorrhoids may be very painful
 Nevertheless this pain typically resolves in 2 – 3 days.
 The swelling however may take a few weeks to disappear .
A skin tag may remain after healing.
If hemorrhoids are large and cause issues with hygiene, they may produce irritation of the surrounding skin and thus itchiness around the anus.
occur at the anal opening and may hang outside the anus.

5. Hemmoroids causes
The exact cause of symptomatic hemorrhoids is unknown.A number of factors are believed to play a role including:
irregular bowel habits (constipation ordiarrhea), a lack of exercise, nutritional factors (low-fiber diets)
increased intra-abdominal pressure (prolonged straining, ascetic, an intra-abdominal mass, or pregnancy)
Genetics
obesity, chronic cough 
Sitting for long period of time
Heavy lifting

6. Epidemiology
Age
More common with advancing age: peaks between 45 and 65 years of age
Uncommon in infants: if present, look for underlying cause (venacaval or mesenteric obstruction, cirrhosis, portal hypertension)
Gender
Equal incidence between males and females.

7. Nonpharmacological treatment
You may need a day or more of bed rest to take pressure off inflamed, irritated veins.
If you are 3 to 6 months pregnant, you may find it helpful to lie on your side.
If you are not pregnant, sleeping on your stomach with a pillow under your hips will help decrease swelling of hemorrhoids.
Try not to sit or stand for a long time when hemorrhoids are irritated.
If you must sit for a long time, sit on a pillow.
Avoid lifting heavy objects.

8. Wear cotton underwear to prevent moisture buildup, which can irritate hemorrhoids.
Wear loose clothing to allow freedom of movement and to reduce pressure on the anal area.
Use soaps that contain no perfumes or dyes.
After cleansing, gently pat the anal area dry with a soft, absorbent towel or cloth.
Baby wipes or other premoistened towels are also useful for this purpose.

9. Take a sitz bath. Fill your bathtub with just enough warm water to cover the anal area. Do this several times a day, especially after you have had a bowel movement. Soak for about 15 minutes at a time.
Exercise ,water ,fiber also useful to eradicate constipation

10. medications Local anaesthetics: Benzocaine,Cinchocaine,lidocaine.
They reversibly block excitation of pain receptors and sensory nerve fibres in and around the area of application
weak basic amines.

11. Local anaesthetics avialable as creams,ointments,supp
Esracaine Rectozorin proctoglyvernol

12. Astringents:
Allantoin, bismuthoxide, bismuthsubgallate, zinc oxide.
Astringents coagulate protein in skin and mucous membrane cells to form asuperficial protective layer.
By reducing the secretion of mucus and intracellular contents from damaged cells, they help to relieve local irritation and inflammation.

13. Anti-inflammatories:
There is only hydrocortisone acetate.
Use of haemorrhoidal preparations containing hydrocortisone is subject to several licensing restrictions: they should not be used for patients under 18 years of age, or during pregnancy or breastfeeding. They should not be used for more than7 days.
An example of medication :proctocare,hemoral HC

14. Fibrinolytic agent:
Mucopolysaccharide polysulphate has achemical structure similar to that of heparin. It is claimed to promote fibrinolysis and to break up small blood clots,and also to possess anti-inflammatory and anti-exudative properties.
They help in healing and resolution of acutely inflamed haemorrhoids.

15. Sclerosing agent:
Lauromacrogol400 is a non-ionicsurfactant that has been used as asclerosing agent in the treatment of varicose veins.
Its involves injecting a Sclerosing agent into avaricosed vein to create fibrosis and close off the lumen.
The technique appears to be not effective in external haemorrhoids.

16. Skin protectant:
Shark liver oil has been used as asource of vitaminA,and both it and cod liver Oil have been used as skin protectants.
However, US Food and Drug Administration advisory review panel found alack of demonstrated effectiveness.

17. Administration and dosage forms
The recommended treatment regimen for most preparations is twice daily,morning and evening, and after each bowel movement.
Products containing hydrocortisone should not be used more than 3-4 times in24 hours.
The base of all products are likely to an additional emollient, Soothing effect and lubricating effect of suppositories may ease straining at stool.

18. Product selection points
Products containing alocal anaesthetic and constituents with mechanical Protective or astringent properties would be logical choices.
Products containing hydrocortisone may be useful for inflammation and Irritation associated with haemorrhoids.
Creams and ointments are considered preferable to suppositories.