There are two types of hemroids: internal hemroids and external hemroids. The two types get their names from the set of hemorrhoidal veins they affect and the place where they are located.
Like most rectal diseases, physicians diagnose hemroids by inspecting the anal area with a gloved finger, and looking inside the anal canal with a small short scope (named “anoscope”). If there is rectal bleeding, it is important that a physician also checks for other more dangerous causes of bleeding, such as colorectal cancer. This evaluation is usually done with a long flexible telescope (named “flexible sigmoidoscopy” or “colonoscopy”).
Internal hemroids are located within the anal cavity. Because this hemorrhoids are somewhat protected within the body, they don’t exhibit as many symptoms as external hemroids and they are less painful. They can be recognize by:
- rectal bleeding
- skin irritation
Whereas the anal cushion of an internal hemroid continues to enlarge, it swells into the anal canal. It may even pull down a part of the lining of the rectum above, and bring out from the anus. This situation is referred to as a prolapsing internal hemroid.
In the anal canal, the internal hemroids can be affected to the passing stool, especially hard stools associated with constipation. The trauma can cause rectal bleeding or hemroids bleeding, discomfort and pain when stool passes. The rectal lining that has been pulled down secretes mucus and moistens the anus and the surrounding skin. Stool also can leak onto the anal skin. The presence of stool and constant moisture can lead to anal itching and skin irritation. The prolapsing hemroids usually return into the rectum on its own or can be pushed back inside, but they will prolapse again with the next bowel movement.
External hemroids is easier to recognize because they can be visually seen or felt as a small bump located near the anal opening. The typical symptoms of hemroids are:
- rectal pain
External hemroids usually can cause few of the symptoms that are typical of internal hemroids. This is because, as shown in the image above, they are located low in the anal canal and have little effect on the function of the anus. External hemroids can cause problems, however, when blood clots inside them. This is referred to as thrombosis. Thrombosis of an external hemroids causes an anal lump that is very painful (because the area is supplied by somatic nerves) and often requires medical attention. The thrombosed hemroid may heal with scarring and leave a tag of skin brought out from the anus. Sometimes, the tag is large, which can make anal hygiene difficult or irritate the anus.
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