WHAT ARE HEMORRHOIDS?
It is important to remember that hemorrhoidal tissue is part of the normal anatomy of all people. Only in a few people do hemorrhoids enlarge or have other symptoms. Hemorrhoidal tissue is located in the anal canal and perianal area and consists of blood vessels, connective tissue and a small amount of muscle.
There are two main types of hemorrhoids: internal and external hemorrhoids. Internal hemorrhoids are covered by a mucous membrane called mucosa, which is not sensitive to touch, pain, stretching or temperature, while external hemorrhoids are covered by skin, which is very sensitive. When problems arise, these two types of hemorrhoids can have very different symptoms and treatments.
SYMPTOMS
About 5% of people with hemorrhoids have symptoms, and only a small fraction require surgery. Patients may experience symptoms of internal or external hemorrhoids, or both.
Most patients with rectal symptoms presenting to a colorectal surgeon complain of hemorrhoids, but a thorough history and examination by an experienced doctor is needed to make an accurate diagnosis. Some patients experience long-term discomfort unrelated to hemorrhoid disease. Other serious diseases, such as anal and colon cancer, should be ruled out after consultation with a specialist familiar with evaluating the anal and rectal area.
INTERNAL HEMORRHOIDS
Painless rectal bleeding or prolapse of anal tissues is often accompanied by symptomatic internal hemorrhoids. A prolapse is an internal hemorrhoid, which is often felt outside the rectum when wiping or defecating. The tissue usually retracts spontaneously, or the patient may push it inward. Symptoms develop slowly over a long period of time and are frequently intermittent.
Internal hemorrhoids are classified according to the degree of prolapse, which helps determine treatment:
Bleeding from internal hemorrhoids is typically bright red and can be quite rapid. It may settle on toilet paper, drip onto the toilet bowl or leave traces in the stool. Not all patients with symptomatic internal hemorrhoids experience significant bleeding. Rather, prolapse may be the main or only symptom. The protruding tissue can cause severe irritation and itching around the anus. Patients may also complain of mucous discharge, difficulty washing after defecation or a feeling that the stool is “stuck” in the rectum during CM. Patients without significant symptoms of internal hemorrhoids do not need to be treated for their presence alone.
What to expect from a specialist
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DENTAL HEMORRHOIDS.
Symptomatic external hemorrhoids usually manifest as a bluish, painful lump just outside the anus. They appear spontaneously and may be preceded by unusual tightness. The skin covering the outside of the anus often adheres firmly to the subcutaneous tissue. If a clot or thrombus forms at this attachment site, the pressure on this tissue increases rapidly and frequently causes pain. The pain is frequently constant and can be severe. Sometimes, strong pressure on a thrombosed external hemorrhoid causes the skin to tear and leak clotted blood. Patients may also complain of occasional swelling, pressure and discomfort caused by external hemorrhoids without thrombosis.
ANAL SKIN TAGS.
Patients often complain of painful soft tissue that can be palpated outside the anus. This may be a remnant of a previous external hemorrhoid problem. The blood clot stretches the skin over the anus, and after the blood clot is absorbed into the body, the skin remains stretched, forming a skin flap. In other cases, patients without a clear history may have skin tags. Sometimes patients suffer from skin tags because they can't clean their rectum after urinating, while others simply think they don't look pretty. Usually, nothing is done to treat them except sedation. Sometimes, however, surgical removal is considered.
WHAT CAUSES SYMPTOMATIC HEMORRHOIDS?
Most symptomatic causes of hemorrhoids miracle are related to increased pressure in the abdomen that spreads to the rectum. Some of these factors are straining to defecate, constipation, diarrhea, pregnancy, and irregular bowel movements. Over time, these factors seem to contribute to the internal hemorrhoid tissue becoming too large and the external hemorrhoid tissue becoming larger or developing blood clots.