Woman of Insight

What Are Hemorrhoids?

First of all, hemorrhoids are not cancer and never turn to cancer. Rather, they are simply varicose veins that just happen to be located at the wrong place at the wrong time. Hemorrhoids only occur in the last inch of the rectum called the anal canal. They are never found further within the colon. All of us normally have many small veins in this area to allow circulation of blood. Straining to eliminate - especially when constipated - causes these veins to temporarily swell. Repeated straining causes them to remain swollen. Then they are termed hemorrhoids.

Internal and External Hemorrhoids

Hemorrhoids come in two types, classified by location. Those located around the outside of the anal opening are called external hemorrhoids. Internal hemorrhoids are located just about 1/2 inch inside the anal opening. This distinction is important since external hemorrhoids are covered by normal skin which has many pain receptors, whereas internal hemorrhoids lack any nerve fibers and are usually painless. The internal hemorrhoids photo shown below is a view from inside. The black tube (scope) you see is coming into the rectum through the anus. The end of the scope, from where the camera is positioned, has been angled back down toward the anus from the inside for this photo.

What Are The Symptoms?

Although many people have hemorrhoids, most do not have symptoms. When they do, the most common symptom of internal hemorrhoids is bright red blood covering the stool, on the toilet tissue, or in the toilet bowl. If internal hemorrhoids become large enough and loose enough, they may drop down and protrude through the anal opening when you strain to have a bowel movement. This prolapsed hemorrhoid can be felt as a bulge and may cause a dull rectal pain. Internal hemorrhoids are classified by the degree of prolapse. Grade I internal hemorrhoids don't prolapse at all. Grade II drop down with a bowel movement but then pop back up inside spontaneously. Grade III must be manually pushed back inside. Grade IV cannot be manually reinserted and are the most severe.

External hemorrhoids are always outside by definition. They rarely bleed, but can cause embarrassing rectal itching and soreness. Rarely, a blood clot can form within an external hemorrhoid turning it blue. This thrombosed hemorrhoid causes sudden severe rectal pain and usually requires a trip to the Emergency Department or surgeon's office. Sitz baths, sitting in a few inches of warm water in a tub, several times a day may ease the pain of a clot enough that surgery is not needed. But if the pain is too severe, or the thrombosed hemorrhoid is large, you probably will be better off having the thrombosed hemorrhoid treated with a small surgical procedure. This can be done with just local anesthesia. A small opening is made over the lump so the clot of blood can be removed.