DIAGNOSIS What are Hemorrhoids? Hemorrhoids are abnormalities of the blood vessels on the inside of the anal canal (internal hemorrhoids) or those on outside of the anal canal (external hemorrhoids). Hemorrhoids can cause bleeding, pain, discomfort, anal itching and/or leakage of mucous or stool. Sometimes there can be excess tissue that comes out of the anus (prolapse) or external swelling (thrombosis).
What are Internal Hemorrhoids and what are the symptoms? Internal hemorrhoids are abnormalities of the blood vessels on the inside and at the top of the anal canal. Constipation with straining at BM’s or diarrhea with multiple BM’s causes the hemorrhoids to become symptomatic.
1. Painless bleeding: Internal hemorrhoids most often cause painless bleeding after a hard BM because the movement irritates the blood vessels.
2. Occasional discomfort; usually internal hemorrhoids don’t cause severe pain.
3. Prolapse of tissue through the anal canal can cause a fullness feeling or leakage of blood or mucous. The prolapsed tissue sometimes goes back on it’s own and at other times it needs to be pushed back by the patient.
Grading classification of Internal Hemorrhoids
Grade I:
Bleeding only
Grade II: Bleeding and prolapse. The prolapsed tissue goes back into anus on its own.
Grade III: Bleeding and prolapse. The prolapsed tissue needs to be pushed back by the patient.
GradelV: Bleeding and prolapse. The prolapsed tissue does not go back with the patient applying pressure.
What are External Hemorrhoids and what are the symptoms?
External hemorrhoids are abnormalities of the blood vessels on the outside of the anal canal. Like internal hemorrhoids, constipation with straining at BM’s or diarrhea with multiple BM’s cause external hemorrhoids to become symptomatic.
4. Severe pain and swelling: When a blood vessel ruptures it causes a blood clot under the perianal skin that can take anywhere from 1-3 weeks to resolve.
5. Bleeding: sometimes the thrombosed hemorrhoid erodes through the skin and there is bleeding.
6. Difficulty with hygiene: Residual tissue from the thrombosis/swelling results in painless skin tags that can cause difficulty keeping the perianal area clean.
7. Itching: Often the stool and mucous that cling to the external residual tags leads to itching.
TREATMENT Prevention is the best treatment.
1. A diet high in fiber including several (6 or more servings) fruits and vegetables daily.
2. Eight 10 ounce glasses of water or juice daily.
3. At least one tablespoon of a fiber supplement such as Metamucil or benefiber daily. Topical Treatments such as Anusol HC, Analpram, Proctofoam, Preparation H: help with swelling, itching and discomfort but are not for long term use.
Excision of Thrombosed External Hemorrhoids: These can be excised in the office if there is severe acute pain and swelling. The goal is to remove the clot which will relieve some of the pain and pressure, however there will still be pain later from the incision.
Rubber Banding of Internal Hemorrhoids: This procedure is only for internal hemorrhoids and it helps treat the bleeding and prolapse of the hemorrhoids. The rubber band is applied in the office using a suction applicator. This is not painful but will cause a feeling of pressure while the band is in place. The tissue becomes strangulated and then falls off a few days after the banding. A scar then forms in the anal canal which tethers the hemorrhoids in their normal anatomic position so they no longer prolapse.
Formal Surgical Excision: Reserved for significant hemorrhoidal disease such as very large external tags that cause discomfort or internal hemorrhoids that are not amenable to banding. Not all tags or internal hemorrhoids are amenable to surgery.
