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  • Hemorrhoids

  • 455.0 Internal hemorrhoids without mention of complication
  • 455.1 Internal thrombosed hemorrhoids
  • 455.2 Internal hemorrhoids with other complication
  • 455.3 External hemorrhoids without mention of complication
  • 455.4 External thrombosed hemorrhoids
  • 455.5 External hemorrhoids with other complication
  • 455.6 Unspecified hemorrhoids without mention of complication
  • 455.7 Unspecified thrombosed hemorrhoids
  • 455.8 Unspecified hemorrhoids with other complication
  • 455.9 Residual hemorrhoidal skin tags

  • 315.4 Developmental coordination disorder
  • 718.45 Contracture of joint, pelvic region and thigh
  • 719.70 Difficulty in walking
  • 728.2 Muscular wasting and disuse atrophy
  • 728.89 Other disorders of muscle, ligament, and fascia
  • 729.9 Other disorders of soft tissue
  • 780.7 Malaise and fatigue
  • 781.2 Abnormality of gait
  • 782.3 Edema
  • 786.0 Dyspnea and respiratory abnormalities
  • 786.05 Shortness of breath

  • I84 Haemorrhoids
  • K64.8 Other hemorrhoids
  • K64.9 Unspecified hemorrhoids


  • Bright red rectal bleeding, usually associated with bowel movements
  • Bulging of the veins around the anus: internal, external, or protruding
  • Superficial pain in rectal area, especially with sitting or attempting to evacuate bowels

Essentials of Diagnosis

  • Rectal pain
  • Increased rectal pain with attempts at evacuating bowels
  • Bright red bleeding

General Considerations

  • Diagnosis for more occult problems may take time and require intensive diagnostic testing
  • Rectal bleeding may be indicative of more serious medical problems
    • Pathology in multiple organ systems
    • GI pathology, especially intestinal, liver
    • Cardiovascular pathology
  • May result in secondary problems such as aerobic capacity and muscle endurance impairment, sarcopenia, weakness/impaired muscle performance, musculoskeletal problems, weight gain (secondary to reduced physical activity due to discomfort or bleeding), indicating the need for physical therapy intervention depending on severity
  • As hemorrhoids may refer pain to the back, they should be considered in the differential diagnoses when an individual is referred to PT for back pain


  • Common in pregnancy
  • More common with aging, usually over 50 years of age
  • Higher occurrence with obesity
  • Exact frequency unknown, estimated 4%

Signs and Symptoms

  • Diarrhea
  • Constipation
  • Lump(s) in anal area
  • Painless bleeding
  • Itching
  • Pain in anal/rectal area
  • Inflammation
  • Swelling
  • Fecal leakage
  • Dizziness
  • Fainting
  • Lightheadedness
  • Back pain
  • Leg pain
  • Depression
  • Anemia
  • Fatigue
  • Pallor
  • Rapid heart rate
  • Weakness
  • Headaches
  • Shortness of breath
  • Difficulty concentrating

Functional Implications

  • Severe symptoms including rectal, leg, or back pain
  • Swelling in anal area
  • Bleeding with need to wear protective pads
  • Decreased exercise tolerance
  • Sleep disturbance if condition is stressful
  • Eating disorders
  • Constipation or bowel retention secondary to fear of moving bowels
  • Limitations in ADLs or IADLs
  • Infection (systemic or local)
  • Headaches
  • Dizziness
  • Fatigue

Possible Contributing Causes

  • Bowel straining
  • Genetics
  • Anal intercourse
  • Chronic constipation
  • Chronic diarrhea
  • ...

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