Hemorrhoid Symptoms and Diagnosis: Internal and External Hemorrhoids

Hemorrhoids occur when veins in the skin around the anus or in the lower rectum get swollen and inflamed. It’s not exactly clear what causes people to get hemorrhoids, but there are some common, accepted risk factors and conditions that lead to their development.

Aging can decrease muscle tone in the area, weakening the tissue and causing hemorrhoids to bulge, while obesity and pregnancy can increase the risk for hemorrhoids due to increased pressure on tissue in the area. (1)

Repeated straining to make a bowel movement, as well as constipation, are also associated with hemorrhoids.

Hemorrhoids are generally not dangerous or life-threatening, but they may be painful.

Common Hemorrhoid Symptoms to Watch For

The following signs and symptoms may indicate hemorrhoids:

• Bright red blood on toilet paper, in stool, or in the toilet bowl after a bowel movement
• Anal itching
• Pain around the anus, especially while sitting
• Pain during bowel movements
• One or more hard, painful lumps around the anus

If you have any symptoms of hemorrhoids, try to avoid excessive straining, rubbing, or cleaning around the anus.

Doing these things can make any irritation and itching worse, and can sometimes lead to bleeding.

Internal Hemorrhoids vs. External Hemorrhoids

There are two main types of hemorrhoids:

Internal Hemorrhoids These hemorrhoids develop inside the lower rectum. Internal hemorrhoids usually don’t hurt, but they often bleed painlessly, resulting in bright red blood you might notice when you go to the bathroom and wipe.

Most of the time, internal hemorrhoids are not visible to the naked eye. But in some cases, internal hemorrhoids may protrude through the anus, which is known as becoming prolapsed. When this happens, they will usually shrink back inside the rectum on their own. Protruding hemorrhoids can become irritated and itchy, and patients may find it difficult to clean themselves after a bowel movement.

Internal hemorrhoids are categorized by how prolapsed they are, which helps determine how they should be treated.

Grade 1 hemorrhoids means there is no prolapse. A prolapse that goes back in by itself is categorized as grade 2. Prolapse that needs to be pushed back in by the patient is considered grade 3. Grade 4 is when the prolapse can’t be pushed back in. (2)

External Hemorrhoids These hemorrhoids develop under the skin around the outside of the anus. They can be itchy or painful, and may feel lumpy.

External hemorrhoids are called thrombosed hemorrhoids when a blood clot develops within the hemorrhoid. The increased pressure can be very painful, especially within the first 48 hours after it develops. (1)

Thrombosed hemorrhoids tend to be bluish in color due to the clot. Sometimes the blood clot will go away on its own, but because the clot has stretched the skin, it may result in an anal skin tag — excess skin left when the blood clot in a thrombosed hemorrhoid is absorbed by the body. Skin tags do not require removal, but if it’s particularly bothersome to a patient, excision is an option. (1)

If a thrombosed hemorrhoid has been present for longer than two days, the pain has often peaked and you might try home treatments while waiting for the clot to clear up on its own. When the clot first forms, it can be very painful; if you make it to your doctor’s office during this time, an in-office surgical procedure, involving local anesthesia and excision of the hemorrhoidal tissue, may be available. (2)

RELATED: 8 Myths You’ve Been Told About Hemorrhoids

How Hemorrhoids Are Diagnosed by Your Doctor

See your doctor if you think you might have hemorrhoids, especially if you notice bleeding from your anus or rectum, or have bloody stools. Your doctor will want to rule out more serious problems that can cause bleeding from the anus or rectum, such as cancer.

Hemorrhoid symptoms may also be similar to those of other anal and rectal problems, including anal fissures, abscesses, warts, and polyps.

Your doctor will ask about your medical history and will ask you to describe your symptoms. Questions about your eating habits, toilet habits, and enema and laxative use are likely to come up. (3)

Your doctor will also perform a physical exam to look for lumps or swelling, prolapsed internal hemorrhoids, external hemorrhoids, skin irritation, skin tags, and anal fissures, which are small tears in the anus that can result in itching and bleeding. (3) This will involve a visual examination of the area.

Your doctor may also perform a rectal exam to diagnose internal hemorrhoids, check the muscle tone of your anus, and check for blood in the stool. This is done with a gloved, lubricated finger (called a digital rectal examination) and a tool called an anoscope.

An anoscope is a type of endoscope — a hollow, lighted tube that is inserted a few inches into the anus to help the doctor see any problems inside the lining of the rectum. This procedure is performed in the doctor’s office and doesn’t require anesthesia. (3)

Your doctor may also recommend additional tests to rule out other causes of bleeding, especially if you are over age 40.

These tests may include:

Colonoscopy After you’re sedated with medicine, your doctor uses a thin, flexible tube called a colonoscope to look at the inner lining of your colon.

A colonoscopy can help discover ulcers, polyps, tumors, and other areas of inflammation or bleeding.

Sigmoidoscopy This procedure is similar to a colonoscopy, but it uses a shorter tube called a sigmoidoscope to examine the lining of the rectum and the sigmoid colon (the lower part of the colon).

Barium Enema X-ray This is a special type of X-ray of the colon and rectum in which your doctor inserts a liquid solution containing barium sulfate into the rectum. The solution helps highlight specific areas in the colon for your doctor to examine in the X-ray images.

RELATED: 4 Signs Your Hemorrhoids Warrant a Doctor’s Visit

Additional reporting by Deborah Shapiro.

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What causes hemorrhoids, and when should you see a doctor?

If you’re experiencing discomfort in your anal area, one of the first things that come to mind for many of us is hemorrhoids.  

That’s the big misnomer.

“Hemorrhoids are the great scapegoats for all sorts of anal issues and discomfort,” says Sean Langenfeld, MD, Nebraska Medicine colon and rectal surgeon. “Because of their location, it’s very difficult for most people to know what’s going on with their anus so they assume it’s hemorrhoids. Less than 50% of people who complain of hemorrhoids actually have hemorrhoids that cause symptoms. More often, they have other diagnoses ranging from small issues such as pruritus ani (anal itching), anal warts, or anal fissures to large issues such as abscesses, fistulas and cancers.”  

Derrick Eichele, MD, Nebraska Medicine gastroenterologist, agrees, and adds, “If you do experience new onset bleeding, it’s better to get it checked early with your primary care doctor than to wait. This will allow us to rule out other alternative competing diagnoses and get you the appropriate treatment.”

What are hemorrhoids?

Hemorrhoids are vascular cushions that live inside the anal canal. They are a part of normal human anatomy. Everyone is born with three of them. These internal hemorrhoids help keep the anus closed at rest, which helps with continence. Hemorrhoids can become uncomfortable when they are swollen and inflamed. Common causes include constipation and straining, prolonged sitting on the toilet, pregnancy and strenuous exercise.

Hemorrhoids fall into two categories.

Internal hemorrhoids

Internal hemorrhoids are the most common type. Despite commonly-held beliefs, hemorrhoids are not usually painful. They can cause painless, bright red bleeding and may bulge outside the anal opening, also known as prolapse, during bowel movements. If they get large enough, patients may see or feel a soft, pink bulge of tissue prolapsing out of their anus. This tissue goes back inside on its own, but sometimes it needs to be pushed back in.

External hemorrhoids

An external hemorrhoid is a soft cushion of skin-covered vascular tissue that lives just outside the anal opening. Severe straining and strenuous exercise can cause these tiny vessels to rupture, which is similar to a blood blister. The ruptured or thrombosed hemorrhoid can grow under the skin and become firm and painful. It is usually dark blue in color and often ruptures producing small dark blood clots.

While thrombosed hemorrhoids are very painful, they are not dangerous to your health and improve over time similar to a skin bruise. If the pain is severe, they can often be removed in the office by a colorectal surgeon. 

Home remedies to relieve hemorrhoids

If you suspect you may have hemorrhoids, Dr. Langenfeld suggests making the following lifestyle changes that can help relieve your symptoms usually within two to seven days:

1. Add more fiber to your diet such as fruits, vegetables, grains and beans.
2. Drink more water.
3. Refrain from straining or prolonged sitting during bowel movements.
4. Over-the-counter creams for hemorrhoids are of little benefit overall but may help temporarily ease pain and swelling.
5. A sitz bath, which involves sitting in warm salt water for 15 to 30 minutes, can help relieve pain and swelling. 

“In many cases, a suspected case of hemorrhoids ends up being a different issue,” notes Dr. Langenfeld. “If the anal symptoms do not get better in a short period of time, a visit with your doctor can help determine if another issue exists. People who are searching hemorrhoids on the Internet should try to find a reliable online resource, such as the American Society of Colon & Rectal Surgeons website. They should also be searching anal fissure since this is a much more common cause of anal complaints.”

Other possible causes of hemorrhoid-like symptoms

Anal itching (pruritus ani) – itching near the anal opening due to irritation to the skin in the area. 

Anal warts – caused by the human papilloma virus (HPV), anal warts are caused from direct sexual contact with an infected person. 

Anal abscess – an infected cavity of puss near the anal opening usually caused by an infection of one of the anal glands usually inside the anal opening.  

Anal fissure – a tear in the skin just inside the anal opening usually caused by trauma to the anal canal such as a large, hard bowel movement.

Anal fistula – a small tunnel connecting a previously infected anal gland with the skin outside the anal opening usually caused by a previous anal abscess. 

When to call your doctor

“Hemorrhoids are not dangerous and typically don’t turn into more severe problems, but they can be distressing and uncomfortable,” says Dr. Langenfeld. “The important thing is to rule out other causes if they do not go away on their own within one to two weeks after trying some simple lifestyle changes.”

If you continue to have rectal bleeding, depending on your age and risk factors, your doctor may recommend a colonoscopy to rule out other possible sources of blood loss, says Dr. Langenfeld.  

Who treats hemorrhoids

“Your primary care doctor can determine your diagnosis and help you implement lifestyle changes to alleviate your symptoms,” says Dr. Langenfeld. “If symptoms linger, your primary care doctor may refer you to a gastroenterologist or colorectal surgeon for treatment.”

Surgery for hemorrhoids

Hemorrhoids that cause moderate or severe symptoms may require surgery. “The most common office procedure for hemorrhoids is rubber band ligation. 

“Rubber band ligation is a safe, effective and pain-free procedure that can be performed in your doctor’s office that involves placing a rubber ligature tightly around the internal hemorrhoid to cut off the blood supply,” explains Dr. Langenfeld. “This will cause the hemorrhoid to shrink and eventually slough off over one to two weeks.”
  
A severe thrombosed hemorrhoid may require excision, which can often be performed in your doctor’s office. This involves making a small incision to drain the clot and usually brings significant relief, notes Dr. Langenfeld.

Need an evaluation?
Suspect you may have hemorrhoids or another type of anal issue?  Call 800. 922.000 to schedule an appointment with one of our doctors.

articles of the Oxford Medical Center Kryvyi Rih

Hemorrhoids is a disease that is always heard, BUT many patients are not serious about its first signs. Wikipedia tells us that HEMORRHOIDS is a disease in proctology, a pathological expansion of hemorrhoidal veins, their inflammation, which contributes to the development of hemorrhoids.

Symptoms of hemorrhoids are very diverse and only a doctor can deal with them. The signs that are characteristic of this disease coincide with the manifestations of rectal cancer, and only an experienced proctologist can make a correct diagnosis and prescribe treatment. It is important to recognize the first symptoms in time and immediately consult a doctor, because hemorrhoids can lead to serious consequences:

With all the inconvenience that accompanies this disease, people do not rush to see a doctor for help, they all hope for “maybe it will go away on its own” – this is the whole reason for such a large percentage of chronic diseases.

Our proctologists at the appointment always try to explain to the patient in an accessible way that inflamed hemorrhoids will not disappear anywhere and it is necessary to immediately use the treatment in order not to bring it to the chronic stage. In the chronic stage, the disease can resume at any time with more serious symptoms and at the most inopportune moment due to the slightest misconduct: nutrition, heaviness, stress.

What are the conditions for visiting a proctologist?

• if you are 30 years old or older and your relatives have suffered from hemorrhoids (there is a predisposition to varicose veins), then you should have an annual examination by a proctologist even if you do not have symptoms. In this case, prevention is the best treatment;

• there is discomfort in the anus – this is the first signal that can warn you about the development of hemorrhoids;

• swelling, inflammation or displacement of the anal folds at certain times;

• anal itching, mucus, burning already indicate prolapsed hemorrhoids;

• discharge of blood on toilet paper, in feces is a characteristic symptom of hemorrhoids. In this case, immediately go to the doctor, because the disease progresses.

• prolapse of hemorrhoids – already directly indicates the presence of hemorrhoids and the need for its urgent treatment.

If you understand that you have a health problem in this area, but do not know where to turn, go to a PROCTOLOGIST. You should not waste time and life on self-treatment and folk methods, you just start the disease and give it the opportunity to progress.

Hemorrhoids are a disease that can be cured, any proctologist will confirm this to you. The main thing is the timely appeal for help!

Our medical center will provide you with the most comfortable appointment with a proctologist and the most effective and fastest treatment methods.

Make an appointment with a proctologist by phone:

( 056) 409-3000, (067) 560-01-02

Published: 02/19/2020

Updated : 02/19/2020

( Rating: 4. 60, votes: 5 )

Treatment of hemorrhoids free of charge under the compulsory medical insurance policy – MSZ.RF

Head of the Department of Coloproctology, City Clinical Hospital No. 15 named after O.M. Filatov about a disease that is not customary to discuss.

Hemorrhoids are a disease of our time, with which almost everyone is familiar. And yet, many believe that the symptoms of the disease are more of a joke than a visit to the doctor. Why such a position is dangerous and why it is so important not to ignore the first signs of hemorrhoids, said the head of the department of coloproctology of the City Clinical Hospital No. O.M. Filatova, Doctor of Medical Sciences Eteri Enverovna Bolkvadze.

Sometimes you sit and sit at work, and suddenly it becomes uncomfortable to sit… Is this a reason to talk to a doctor? Yes, because it is quite possible that this is hemorrhoids, when varicose veins of the rectum leads to the appearance and pathological increase in hemorrhoids. Then these nodes, depending on the stage of the disease, can grow, become inflamed, bleed and fall out of the anus.

— How many stages will pass before a slight discomfort becomes unbearable?

• The disease has a chronic and acute form. There are 3 stages of acute hemorrhoids:
• – thrombosis without inflammation;
• – thrombosis with inflammation;
• – thrombosis with inflammation extending to the perianal skin and subcutaneous tissue.

• For chronic hemorrhoids stage 4:
• Stage 1: bleeding without prolapse of hemorrhoids.
• stage 2: hemorrhoids prolapse, which is accompanied by bleeding.
• Stage 3: hemorrhoids prolapse with or without bleeding, the nodes can be set on their own.
• stage 4: large hemorrhoids cannot be reduced by themselves, may or may not be accompanied by bleeding.

— Where does the disease “legs grow” from? What are the causes of hemorrhoids?

One of the main reasons is a sedentary lifestyle. For example, when you are at the computer all day long, congestion occurs in the pelvic organs, varicose veins swell and become inflamed – that’s hemorrhoids for you. The cause can also be malnutrition and, as a result, chronic constipation. Hemorrhoids often occur during pregnancy. There is also a hereditary predisposition to the disease.

It is believed that stress can be the cause of hemorrhoids. There is no direct influence, but experiences can cause constipation, and this, in turn, can provoke hemorrhoids.

— Why is “non-dangerous” hemorrhoids dangerous?

Complications. The inflammatory process in the surrounding tissue in acute thrombosis can lead to the development of paraproctitis, a purulent inflammatory disease.

By the way, the proctology department of the City Clinical Hospital No. 15 named after. O.M. Filatov is the only one in Moscow where anaerobic paraproctitis is seriously dealt with. This is one of the most formidable proctological diseases. Sphincter-preserving plastic surgery for complex fistulas of the rectum, treatment of extensive anaerobic phlegmon of the perineum with further skin plasty of wound defects … These are very complex and expensive operations, caring for patients who have undergone them is a huge job. In Moscow, no one else is doing this important work.

— What are some alarm bells that are important to hear in time?

The first symptoms of hemorrhoids may be itching, burning in the anus, discomfort after stool, spotting. But it is important to understand that bleeding can be a sign of another disease. If at least one of these symptoms is noticed, you need to go to the doctor without delay. Hemorrhoids can only be diagnosed by a specialist after examinations.

Unfortunately, in medical practice there are cases when a patient pulls and endures to the last, and when he comes to us, a tumor is found during examination. How many of these young patients we see, who should not be treated, but saved. ..

“… proctological department of the City Clinical Hospital No. 15 named after. O.M. Filatov is the only one in Moscow where anaerobic paraproctitis is seriously dealt with.”

— What types of diagnostics do you need to be prepared for?

Timely diagnosis is very important. It is recommended to visit a proctologist annually. Here is a list of studies that are in the arsenal of a proctologist:

• – Finger examination.
• – Anoscopy, when using a disposable anoscope (they come with illumination), a specialist evaluates the condition of the anal canal and the distal part of the rectum. This type of diagnosis is no less important than a colonoscopy.
• – Sigmoidoscopy, in which the intestine is viewed at 25 centimeters, due to which it is possible to assess the condition of the anal canal, rectum, distal part of the sigmoid colon.
• – Colonoscopy (recommended every two years) is performed if all the tests performed did not reveal the disease. If it is difficult for a patient to withstand a colonoscopy, an irrigoscopy (X-ray with contrast) is done.

Is it necessary to operate on hemorrhoids?

Of course not. It all depends on the stage of the disease. If we are talking about the initial stage, the patient feels only discomfort, itching and burning, then the specialist prescribes ointments, suppositories, therapeutic nutrition to prevent constipation.

When it comes to stage 3-4 disease, if a person has thrombosis more than twice a year, external hemorrhoids swell and fall out of the rectum, and the bleeding is so profuse that it causes anemia, surgery is needed.

— How can a proctologist help in such cases?

In the initial stages of hemorrhoids, if the internal nodule is small, but it bleeds, a procedure such as sclerotherapy is performed. As a result, the bleeding stops.

If the hemorrhoid is large and prolapsed, which is common in older patients, hemorrhoid desarterization with Doppler-guided mucopexy can be done. The essence of the method is to use the Doppler to find the vessel and the upper branches of the hemorrhoidal artery, and then flash them. The blood flow in the hemorrhoid stops and the node immediately decreases.

• Depending on the form and stage of the disease, also apply:
• – Thrombectomy.
• – Sclerotherapy.
• – Sclerotherapy in combination with ligation of the hemorrhoid.

If we are talking specifically about the operation, then this is an open or closed hemorrhoidectomy. In any case, the choice of one or another method of treatment depends on many factors, individual for each patient.

In private clinics, the operation with the HAL-RAR device will be very expensive, but we do it free of charge under compulsory health insurance.

— What innovative methods are used to treat hemorrhoids?

Minimally invasive intervention using the HAL-RAR device, stands for Haemorrhoidal Artery Ligation (ligation of the hemorrhoidal artery), RAR stands for Recto Anal Repair (mucopexy and mucosal lifting). As a result of the intervention, ligation with latex rings stops the arterial blood supply to the nodes, after which the hemorrhoidal plexuses become sclerosed and return to normal sizes. Then one or more mucopexies are performed.

The operation lasts no more than half an hour and is absolutely painless, and the risk of complications after it is minimal. The patient can return to a healthy lifestyle within a few days.

In private clinics, the operation with the HAL-RAR device will be very expensive, but we do it free of charge under compulsory health insurance.

— How to reduce the risk of developing hemorrhoids?

First of all, eliminate constipation, that is, eat right: add coarse fiber (vegetables, fruits, cereals) to your daily diet, do not forget to drink water. It is also important to lead an active lifestyle – move more and sit less on the couch.

— Is the treatment of hemorrhoids available under the CHI policy for patients from other cities?

Of course! If you are a citizen of the Russian Federation with a compulsory medical insurance policy, you have the possibility of planned hospitalization in the City Clinical Hospital No.