Differences between Internal and External Hemorrhoids (Piles)

Hemorrhoids are actually veins in the anal canal that are swollen and often painful. The veins are part of a cushion of blood vessels and connective tissue, and they normally function to assist with control of the passage of waste, but they become pathological when they become swollen or inflamed. Hemorrhoids are a common problem, and though they can hurt, they are usually not serious.

The cause of hemorrhoids is excess pressure on the veins in the pelvic and rectal region. Common hemorrhoid symptoms include bleeding during bowel movements, which may show up on toilet paper or in the toilet bowl. Itching is another common symptom, as is rectal pain. With internal hemorrhoids, you may see bright red blood in the toilet bowl or on the surface of the stool. They may be internal or external, and people who have them often have both types at once.

Internal hemorrhoids commonly are made up of small swollen veins in the walls of the anal canal. However, they can become large enough to bulge out of the anal opening, in which case they are usually painful. If the blood supply to the hemorrhoid is cut off because it is being squeezed by anal muscles, they can be very painful.

An internal hemorrhoid that protrudes from the anal opening is known as a prolapsing internal hemorrhoid. With internal hemorrhoids, exposure to passing waste matter can cause bleeding and pain. Excess moisture, caused by mucus secreted by the rectal lining can cause prolapsing internal ones to itch, though this is not that common. Usually, after a bowel movement, a prolapsing hemorrhoid returns back into the rectal canal, or can be pushed back in manually. It will most likely prolapse again the next time a bowel movement occurs.

External hemorrhoids are usually felt as a bulge at the anal opening, and they usually don’t cause as many or as severe symptoms as internal hemorrhoids. They originate lower in the anal canal and do not have that much of an effect on anal function. But they are enervated by somatic nerves, which can make them more painful than internal hemorrhoids.

External hemorrhoids may bleed, and when the blood pools, it causes a hard painful lump called a thrombosed (clotted) hemorrhoid. This is a complication that may require medical attention. Thrombosed hemorrhoids may leave a scar when they heal, forming a tag of skin that protrudes from the anus and causes irritation and difficulty with hygiene.

Fortunately for most people with hemorrhoids, testing for them is not complicated. Doctors can often diagnose them based on your health history and a brief physical exam that does not involve any equipment. In people over age 50, and in cases where doctors suspect that rectal bleeding has some other cause, however, other tests may be ordered to pinpoint the cause of the bleeding.

Treatment for hemorrhoids ranges from simple measures like taking in extra fluids and dietary fiber to application of topical agents. Generally, it is only in the most severe cases that surgery is proposed as a treatment.

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