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  #1 sophiemay on 25 May 23

   

  Internal Hemorrhoids – Causes and Risk Factors

  
  

  Reviewed by Dr. Valeria Simone MD (Southlake General Surgery, Texas)

  
  

  Many people experience internal hemorrhoids, making it a highly prevalent medical issue. These swollen veins appear within the rectum and anus and are a common source of pain, discomfort, and bleeding.

  
  

  Certain risk factors, including a low-fiber diet, straining during bowel movements, and extended sitting or standing, can contribute to developing this illness, however, the exact cause is not always evident. The following paragraph will discuss how to recognize and treat internal hemorrhoids.

  
  

  What are Internal Hemorrhoids?

  
  

  Internal hemorrhoids are a form of hemorrhoid that occur inside the rectum or the anus. In most cases, they do not cause any pain and may not even generate any obvious symptoms; but, in other cases, they can cause discomfort, bleeding, and itching.

  
  

  There are various distinct varieties of internal hemorrhoids, one of which is known as prolapsed hemorrhoids. This form of internal hemorrhoid develops when the hemorrhoid is pushed out of the anus because of bowel movements.

  
  

  To identify this medical condition, a doctor would often undertake a physical exam and may utilize other diagnostic procedures to rule out other disorders before making a diagnosis of internal hemorrhoids.

  
  

  
  

  
  

  

  
  

  
  

  
  

  Internal hemorrhoids – how common are they?

  
  

  Many people experience this condition, making it a highly prevalent medical issue. Approximately 75% of adults will develop hemorrhoids at some point in their lives, with many instances being internal.

  
  

  However, while they are more prevalent in persons over the age of 50, everyone, of any age, is at risk for developing one. Despite their prevalence, many people may feel embarrassed or uncomfortable talking to their doctor about their symptoms, which can delay diagnosis and treatment.

  
  

  In the United States, internal hemorrhoids impact millions of people each year. This condition is incredibly common, with over 10 million people in the United States seeking treatment for their condition every year.

  
  

  The lack of outward symptoms makes it easy for many people to be unaware that they have this medical condition, despite the condition’s prevalence. To get the help, you need, it’s crucial that you recognize the warning signs and symptoms of internal hemorrhoids.

  
  

  Who’s at risk?

  
  

  Internal hemorrhoids can occur in people of any age, gender, or race; however, there are risk factors that can enhance the likelihood of this happening.

  
  

  This condition is more common in people with a low-fiber diet or constipation because of the strain on the rectum and anus during bowel movements.

  
  

  Pregnant women are also at risk for internal hemorrhoids because of the strain placed on their pelvic veins. Finally, the strain on the veins in the lower body can create swelling, which can lead to internal hemorrhoids for those who sit or stand for long amounts of time.

  
  

  Types of Internal Hemorrhoids

  
  

  There are four distinct degrees of internal hemorrhoid pain and discomfort.

  
  

  
  
  • Grade 1 Hemorrhoids severity hardly perceptible bumps within the anus’s lining.
  
  
  • Grade 2 Hemorrhoids are more noticeable than those of grade 1 and may protrude from the anus during bowel movements before returning to their regular place.
  
  
  • Grade 3 Hemorrhoids are prolapsed hemorrhoids because they push out of the anus and need to be repositioned by hand.
  
  
  • Grade 4 Hemorrhoids are the most severe form and can cause a great deal of discomfort and anguish. These hemorrhoids often protrude from the anus and may need to be repositioned surgically or by hand.
  
  

  
  

  What are the causes of Internal Hemorrhoids?

  
  

  Internal hemorrhoids are caused by an increase in pressure on the veins in the rectum and anus. This increased pressure can be brought on by several different things, including:

  
  

  
  
  • persistent constipation
  
  
  • a diet poor in fiber
  
  
  • pregnancy
  
  

  
  

  Other risk factors for developing internal hemorrhoids include:

  
  

  
  
  • frequently lifting heavy objects
  
  
  • being overweight
  
  
  • being older
  
  
  • sitting or standing for long durations
  
  

  
  

  There are also several medical conditions, such as liver illness and inflammatory bowel disease, that have been linked to an increased likelihood of developing internal hemorrhoids.

  
  

  It is essential to treat any underlying causes of internal hemorrhoids to stop the progression of the condition and avoid future pain and consequences.

  
  

  Symptoms of Internal Hemorrhoids

  
  

  It’s possible that minor cases of internal hemorrhoids won’t create any apparent symptoms. However, if the problem worsens, people may experience:

  
  

  
  
  • pain
  
  
  • bleeding
  
  
  • itching in the anal region
  
  

  
  

  Additionally, some people may feel a lump or swelling close to the anus, and in extremely unusual cases, fecal leakage may take place.

  
  

  Internal hemorrhoids of grades 3 and 4 are generally accompanied by more severe symptoms, such as ongoing pain and trouble with bowel movements. These symptoms can be quite uncomfortable.

  
  

  It is imperative that you get medical attention as soon as possible if you encounter any of these symptoms to receive an accurate diagnosis and appropriate treatment.

  
  

  How to diagnose?

  
  

  A physical exam is the best way to detect internal hemorrhoids. During the exam, a medical professional will evaluate the anus and the rectum for any evidence of swelling or inflammation.

  
  

  To obtain a more detailed image of the region, the medical professional might also carry out a digital rectal exam or make use of a device known as an anoscope.

  
  

  In certain instances, additional diagnostic procedures, such as a colonoscopy or sigmoidoscopy, may be carried out to exclude the possibility that the symptoms are being caused by anything else.

  
  

  It is imperative that you seek medical assistance as soon as possible if you have any reason to believe that you may be suffering from this medical condition.

  
  

  Receiving an accurate diagnosis and treatment as soon as possible can help reduce the risk of complications and eliminate any associated discomfort.

  
  

  What are the complications?

  
  

  Internal hemorrhoids can sometimes lead to thrombosis, which is the creation of a blood clot within the hemorrhoid itself. This is one of the complications of this medical condition.

  
  

  Thrombosis can result in excruciating pain as well as swelling, which may necessitate medical treatment. It is possible for internal hemorrhoids to become prolapsed, in which case they cannot be repositioned manually and may require medical intervention in the form of surgery.

  
  

  The persistent bleeding that results from internal hemorrhoids can cause anemia and exhaustion. In addition, straining during bowel movements because of internal hemorrhoids can lead to the formation of an anal fissure, which is a small tear in the lining of the anus that can cause pain and bleeding. This can be avoided by not straining during bowel movements.

  
  

  Treatment of Internal Hemorrhoids

  
  

  Treatments that do not involve surgery, such as topical lotions, warm sitz baths, and increased fiber consumption, are often effective in managing this medical condition.

  
  

  In more severe cases, a healthcare provider may advise patients to undergo minimally invasive procedures such as sclerotherapy or rubber band ligation.

  
  

  In extremely unusual circumstances, when non-surgical therapy has been unsuccessful, surgical intervention may be required.

  
  

  It is essential to adhere to the treatment suggestions provided by your healthcare professional and to adjust your way of life to reduce the risk of internal hemorrhoids developing or returning in the future.

  
  

  Surgical treatment may include:

  
  

  The use of surgical treatments for internal hemorrhoids is normally reserved for more severe cases that do not respond well to non-surgical methods.

  
  

  Hemorrhoidectomy is the most common type of surgical treatment for internal hemorrhoids. This procedure involves removing the diseased tissue.

  
  

  Other surgical treatments include stapled Hemorrhoidectomy, in which a specialized stapling instrument is used to cut off the blood supply to the afflicted area, and hemorrhoidopexy, in which the hemorrhoids are lifted and secured back into their normal position.

  
  

  Both procedures are performed under general anesthesia.

  
  

  Before making a choice on whether to have surgery for severe cases of this medical condition, it is vital to explore all your treatment choices with your healthcare provider, as well as carefully weigh the potential risks and benefits of each course of action.

  
  

  How to prevent internal hemorrhoids?

  
  

  Changes in lifestyle, such as increasing the amount of fiber in one’s diet, can be made to lower the risk of internal hemorrhoids.

  
  

  Let’s explore more: Internal Hemorrhoids – Causes and Risk Factors - Southlake General Surgery

  
  

  Appointment

  
  

  For more information on “Internal Hemorrhoids – Causes and Risk Factors” and consultation with Dr. Valeria Simone MD, at Southlake General Surgery, Texas, USA. Please contact our healthcare expert today at +1(817) 748-0200. You can also make an online appointment with us.

  
  

  Follow us on Facebook and YouTube.

  
  

  Source: Internal Hemorrhoids – Causes and Risk Factors - Southlake General Surgery

   

  <div class="cArrow"> </div><div class="cContentInner"><p style="padding-left: 240px;"><strong><a target="_top" class="q-box Link___StyledBox-t2xg9c-0 dFkjrQ puppeteer_test_link qu-cursor--pointer qu-hover--textDecoration--underline" href="https://southlakegeneralsurgery.quora.com/Internal-Hemorrhoids-Causes-and-Risk-Factors" rel="nofollow">Internal Hemorrhoids – Causes and Risk Factors</a></strong></p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Reviewed by <span class="q-inline"><a target="_blank" class="q-box Link___StyledBox-t2xg9c-0 dFkjrQ puppeteer_test_link qu-cursor--pointer qu-hover--textDecoration--underline" title="www.southlakegeneralsurgery.com" href="https://www.southlakegeneralsurgery.com/about-us/" rel="noopener nofollow">Dr. Valeria Simone MD (Southlake General Surgery, Texas)</a></span></p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Many people experience internal hemorrhoids, making it a highly prevalent medical issue. These swollen veins appear within the rectum and anus and are a common source of pain, discomfort, and bleeding.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Certain risk factors, including a low-fiber diet, straining during bowel movements, and extended sitting or standing, can contribute to developing this illness, however, the exact cause is not always evident. The following paragraph will discuss how to recognize and treat internal hemorrhoids.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">What are Internal Hemorrhoids?</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Internal hemorrhoids are a form of hemorrhoid that occur inside the rectum or the anus. In most cases, they do not cause any pain and may not even generate any obvious symptoms; but, in other cases, they can cause discomfort, bleeding, and itching.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">There are various distinct varieties of internal hemorrhoids, one of which is known as prolapsed hemorrhoids. This form of internal hemorrhoid develops when the hemorrhoid is pushed out of the anus because of bowel movements.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">To identify this medical condition, a doctor would often undertake a physical exam and may utilize other diagnostic procedures to rule out other disorders before making a diagnosis of internal hemorrhoids.</p> <br /> <div class="q-box"> <br /> <div class="CssComponent-sc-1oskqb9-0 QTextImage___StyledCssComponent-sc-1yi3aau-0 cfUEeh"> <br /> <div class="q-box unzoomed" tabindex="-1"><img class="q-image qu-display--block" src="https://qph.cf2.quoracdn.net/main-qimg-e2ea83f363b8d202e96816bc3a892db2" /></div> <br /> </div> <br /> </div> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Internal hemorrhoids – how common are they?</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Many people experience this condition, making it a highly prevalent medical issue. Approximately 75% of adults will develop hemorrhoids at some point in their lives, with many instances being internal.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">However, while they are more prevalent in persons over the age of 50, everyone, of any age, is at risk for developing one. Despite their prevalence, many people may feel embarrassed or uncomfortable talking to their doctor about their symptoms, which can delay diagnosis and treatment.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">In the United States, internal hemorrhoids impact millions of people each year. This condition is incredibly common, with over 10 million people in the United States seeking treatment for their condition every year.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">The lack of outward symptoms makes it easy for many people to be unaware that they have this medical condition, despite the condition’s prevalence. To get the help, you need, it’s crucial that you recognize the warning signs and symptoms of internal hemorrhoids.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Who’s at risk?</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Internal hemorrhoids can occur in people of any age, gender, or race; however, there are risk factors that can enhance the likelihood of this happening.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">This condition is more common in people with a low-fiber diet or constipation because of the strain on the rectum and anus during bowel movements.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Pregnant women are also at risk for internal hemorrhoids because of the strain placed on their pelvic veins. Finally, the strain on the veins in the lower body can create swelling, which can lead to internal hemorrhoids for those who sit or stand for long amounts of time.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Types of Internal Hemorrhoids</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">There are four distinct degrees of internal hemorrhoid pain and discomfort.</p> <br /> <ul class="q-box"> <br /> <li class="q-relative">Grade 1 Hemorrhoids severity hardly perceptible bumps within the anus’s lining.</li> <br /> <li class="q-relative">Grade 2 Hemorrhoids are more noticeable than those of grade 1 and may protrude from the anus during bowel movements before returning to their regular place.</li> <br /> <li class="q-relative">Grade 3 Hemorrhoids are prolapsed hemorrhoids because they push out of the anus and need to be repositioned by hand.</li> <br /> <li class="q-relative">Grade 4 Hemorrhoids are the most severe form and can cause a great deal of discomfort and anguish. These hemorrhoids often protrude from the anus and may need to be repositioned surgically or by hand.</li> <br /> </ul> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">What are the causes of Internal Hemorrhoids?</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Internal hemorrhoids are caused by an increase in pressure on the veins in the rectum and anus. This increased pressure can be brought on by several different things, including:</p> <br /> <ul class="q-box"> <br /> <li class="q-relative">persistent constipation</li> <br /> <li class="q-relative">a diet poor in fiber</li> <br /> <li class="q-relative">pregnancy</li> <br /> </ul> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Other risk factors for developing internal hemorrhoids include:</p> <br /> <ul class="q-box"> <br /> <li class="q-relative">frequently lifting heavy objects</li> <br /> <li class="q-relative">being overweight</li> <br /> <li class="q-relative">being older</li> <br /> <li class="q-relative">sitting or standing for long durations</li> <br /> </ul> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">There are also several medical conditions, such as liver illness and inflammatory bowel disease, that have been linked to an increased likelihood of developing internal hemorrhoids.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">It is essential to treat any underlying causes of internal hemorrhoids to stop the progression of the condition and avoid future pain and consequences.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Symptoms of Internal Hemorrhoids</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">It’s possible that minor cases of internal hemorrhoids won’t create any apparent symptoms. However, if the problem worsens, people may experience:</p> <br /> <ul class="q-box"> <br /> <li class="q-relative">pain</li> <br /> <li class="q-relative">bleeding</li> <br /> <li class="q-relative">itching in the anal region</li> <br /> </ul> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Additionally, some people may feel a lump or swelling close to the anus, and in extremely unusual cases, fecal leakage may take place.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Internal hemorrhoids of grades 3 and 4 are generally accompanied by more severe symptoms, such as ongoing pain and trouble with bowel movements. These symptoms can be quite uncomfortable.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">It is imperative that you get medical attention as soon as possible if you encounter any of these symptoms to receive an accurate diagnosis and appropriate treatment.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">How to diagnose?</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">A physical exam is the best way to detect internal hemorrhoids. During the exam, a medical professional will evaluate the anus and the rectum for any evidence of swelling or inflammation.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">To obtain a more detailed image of the region, the medical professional might also carry out a digital rectal exam or make use of a device known as an anoscope.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">In certain instances, additional diagnostic procedures, such as a colonoscopy or sigmoidoscopy, may be carried out to exclude the possibility that the symptoms are being caused by anything else.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">It is imperative that you seek medical assistance as soon as possible if you have any reason to believe that you may be suffering from this medical condition.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Receiving an accurate diagnosis and treatment as soon as possible can help reduce the risk of complications and eliminate any associated discomfort.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">What are the complications?</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Internal hemorrhoids can sometimes lead to thrombosis, which is the creation of a blood clot within the hemorrhoid itself. This is one of the complications of this medical condition.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start"><span class="q-inline"><a target="_blank" class="q-box Link___StyledBox-t2xg9c-0 dFkjrQ puppeteer_test_link qu-cursor--pointer qu-hover--textDecoration--underline" title="www.southlakegeneralsurgery.com" href="https://www.southlakegeneralsurgery.com/thrombosed-hemorrhoids-southlake-general-surgery/" rel="noopener nofollow">Thrombosis</a></span> can result in excruciating pain as well as swelling, which may necessitate medical treatment. It is possible for internal hemorrhoids to become prolapsed, in which case they cannot be repositioned manually and may require medical intervention in the form of surgery.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">The persistent bleeding that results from internal hemorrhoids can cause anemia and exhaustion. In addition, straining during bowel movements because of internal hemorrhoids can lead to the formation of an <span class="q-inline"><a target="_blank" class="q-box Link___StyledBox-t2xg9c-0 dFkjrQ puppeteer_test_link qu-cursor--pointer qu-hover--textDecoration--underline" title="www.southlakegeneralsurgery.com" href="https://www.southlakegeneralsurgery.com/anal-fissure-symptoms-diagnosis-prevention-and-treatment/" rel="noopener nofollow">anal fissure</a></span>, which is a small tear in the lining of the anus that can cause pain and bleeding. This can be avoided by not straining during bowel movements.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Treatment of Internal Hemorrhoids</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Treatments that do not involve surgery, such as topical lotions, warm sitz baths, and increased fiber consumption, are often effective in managing this medical condition.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">In more severe cases, a healthcare provider may advise patients to undergo minimally invasive procedures such as sclerotherapy or rubber band ligation.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">In extremely unusual circumstances, when non-surgical therapy has been unsuccessful, surgical intervention may be required.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">It is essential to adhere to the treatment suggestions provided by your healthcare professional and to adjust your way of life to reduce the risk of internal hemorrhoids developing or returning in the future.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Surgical treatment may include:</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">The use of surgical treatments for internal hemorrhoids is normally reserved for more severe cases that do not respond well to non-surgical methods.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Hemorrhoidectomy is the most common type of surgical treatment for internal hemorrhoids. This procedure involves removing the diseased tissue.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Other surgical treatments include stapled Hemorrhoidectomy, in which a specialized stapling instrument is used to cut off the blood supply to the afflicted area, and hemorrhoidopexy, in which the hemorrhoids are lifted and secured back into their normal position.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Both procedures are performed under general anesthesia.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Before making a choice on whether to have surgery for severe cases of this medical condition, it is vital to explore all your treatment choices with your healthcare provider, as well as carefully weigh the potential risks and benefits of each course of action.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">How to prevent internal hemorrhoids?</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Changes in lifestyle, such as increasing the amount of fiber in one’s diet, can be made to lower the risk of internal hemorrhoids.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Let’s explore more: <span class="q-inline"><a target="_blank" class="q-box Link___StyledBox-t2xg9c-0 dFkjrQ puppeteer_test_link qu-cursor--pointer qu-hover--textDecoration--underline" title="www.southlakegeneralsurgery.com" href="https://www.southlakegeneralsurgery.com/internal-hemorrhoids-causes-and-risk-factors/" rel="noopener nofollow">Internal Hemorrhoids – Causes and Risk Factors - Southlake General Surgery</a></span></p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Appointment</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">For more information on “Internal Hemorrhoids – Causes and Risk Factors” and consultation with Dr. Valeria Simone MD, at Southlake General Surgery, Texas, USA. Please contact our healthcare expert today at +1(817) 748-0200. You can also <span class="q-inline"><a target="_blank" class="q-box Link___StyledBox-t2xg9c-0 dFkjrQ puppeteer_test_link qu-cursor--pointer qu-hover--textDecoration--underline" title="www.southlakegeneralsurgery.com" href="https://www.southlakegeneralsurgery.com/make-an-appointment/" rel="noopener nofollow">make an online appointment</a></span> with us.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Follow us on <span class="q-inline"><a target="_blank" class="q-box Link___StyledBox-t2xg9c-0 dFkjrQ puppeteer_test_link qu-cursor--pointer qu-hover--textDecoration--underline" title="www.facebook.com" href="https://www.facebook.com/southlakegeneralsurgery/" rel="noopener nofollow">Facebook</a></span> and <span class="q-inline"><a target="_blank" class="q-box Link___StyledBox-t2xg9c-0 dFkjrQ puppeteer_test_link qu-cursor--pointer qu-hover--textDecoration--underline" title="www.youtube.com" href="https://www.youtube.com/channel/UC52jtLNZsXETpR7nCYAUCpQ" rel="noopener nofollow">YouTube</a></span>.</p> <br /> <p class="q-text qu-display--block qu-wordBreak--break-word qu-textAlign--start">Source: <span class="q-inline"><a target="_blank" class="q-box Link___StyledBox-t2xg9c-0 dFkjrQ puppeteer_test_link qu-cursor--pointer qu-hover--textDecoration--underline" title="www.southlakegeneralsurgery.com" href="https://www.southlakegeneralsurgery.com/internal-hemorrhoids-causes-and-risk-factors/" rel="noopener nofollow">Internal Hemorrhoids – Causes and Risk Factors - Southlake General Surgery</a></span></p></div>

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