You may be surprised to learn that hemorrhoids are a normal part of our anatomy. We have both internal and external hemorrhoids, located inside the anal canal and around the anal opening, respectively. The internal hemorrhoids are a part of the blood supply to the anus and are made up of small arterial branches. In addition, internal hemorrhoids—also known as anal cushions—normally help us maintain continence (hold our gas and stool) and also distinguish gas from stool before we pass gas. The external hemorrhoids are veins.
When they are in their normal state, we are not aware of our hemorrhoids: they cause no symptoms. But, sometimes we can develop problems because of our internal hemorrhoids. This is known as “internal hemorrhoidal disease.” Such symptoms can occur occasionally (“flare ups”) or may be chronic (long-term).
When our external hemorrhoids cause symptoms, it is because a blood clot suddenly forms in one of these veins at the opening of the anus. This is known as a “thrombosed external hemorrhoid.” This blood clot results in a firm external lump that is associated with anal pain and, at times, bleeding between bowel movements.
Hemorrhoidal problems—both internal and external—are common. There are treatment options for you.
The symptoms of internal hemorrhoidal disease include the following:
Various factors can lead to the development of hemorrhoid problems:
Thrombosed external hemorrhoids can occur after straining, either during bowel movements or heavy lifting or vigorous activity. Hard or watery bowel movements can also produce a thrombosed external hemorrhoid.
A diagnosis of a hemorrhoidal problem begins with a visit to your doctor. The doctor will ask about your symptoms and perform a physical examination, including an evaluation of the anal area.
During an anal examination, the doctor will:
In some cases, you may need an additional study such as a flexible sigmoidoscopy or a colonoscopy to ensure that your symptoms are not due to any disease in your colon or rectum.
Various treatments are available for internal hemorrhoidal disease. Not all people will require an office or a surgical procedure.
For milder or occasional symptoms, the following treatments can help:
For more severe or chronic symptoms, other options may be discussed, including office and surgical procedures. The best procedure for you depends on the size of the internal hemorrhoids and how severe your symptoms are.
Techniques for treating internal hemorrhoidal disease include:
In most cases, a thrombosed external hemorrhoid does not require surgery. As the blood clot dissolves, the thrombosed external hemorrhoid shrinks. If appropriate, within the first three days of the appearance of the thrombosed external hemorrhoid, the clot can be removed or the thrombosed external hemorrhoid completely excised (cut out). This is a minor procedure that can usually be done in the office.
Here are some ways to prevent internal hemorrhoidal disease:
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