Understanding The Difference Between External And Internal Hemorrhoids
Its true that the symptoms youre having help identify which type of hemorrhoid youre experiencing. The good news is that treatment exists for all types, and it may be easier than you believe to get rid of the pain and bleeding that often accompany this fairly common problem.
Betsy Clemens, MD, is a specialist who leads our team here at Midwest Hemorrhoid Treatment Center in Creve Coeur, Missouri. She shares insight about hemorrhoid types, their symptoms, and the therapy available to help resolve your discomfort.
Can Natural Home Remedies Treat And Prevent Hemorrhoids
Regardless of the size or swelling of a hemorrhoid, no treatment is required if symptoms do not exist. Prevention is perhaps the most effective treatment. Diet and adequate hydration are very important to maintain normal bowel movements. Hemorrhoid symptoms can occur with the passage of hard stool and constipation, as well as diarrhea and frequent bowel movements. People with constipation may require a high-fiber diet, adequate hydration, and stool softeners. Those with too frequent bowel movements may require antidiarrheal medications and diet adjustments. These preventive measures decrease the amount of straining that is required to have a bowel movement, thus decreasing the pressure within the blood vessels to prevent swelling. The internal hemorrhoid always stays protruded or prolapsed and is at risk for thrombosis or strangulation should the anal muscles go into spasm.
Grade 1 hemorrhoids are treated symptomatically. There can be some spasm of the anal muscles. Warm sitz baths, sitting in a warm tub for 20 minutes, two or three times a day may be helpful. Avoiding spicy food may also prevent anal itching. Over-the-counter medications may be helpful.
What Do External And Internal Hemorrhoids Look Like
Normal hemorrhoidal tissue cannot be seen since they must first swell and become inflamed or develop a clot to cause symptoms. One can see swollen external hemorrhoids or internal prolapsed hemorrhoids exposed outside the anus but internal hemorrhoids cannot be seen because they remain inside the anus. A thrombosed hemorrhoid will appear as a lump at the anal verge, protruding from the anus, and will be dark bluish in color because of the blood clot contained inside the swollen blood vessel. Non-thrombosed hemorrhoids will appear as a rubbery lump. Often more than one swollen hemorrhoid appears at the same time.
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Hemorrhoids Are Common So Dont Be Shy About Seeking Relief
Most people dont want to talk about hemorrhoids. But keeping silent could stand in the way getting relief for a condition thats very common. And your doctor certainly doesnt mind addressing the topic of hemorrhoids. In fact, they want to discuss your symptoms. Because what you think is a hemorrhoid could be something more serious. Its best to get your hemorrhoids checked out early, for your peace of mind and to protect your health.Doctors have seen and heard everything, so you dont have to feel embarrassed when talking about hemorrhoids especially since nearly half of all adults experience them by age 50, says Dr. Christopher Buzas, a colorectal surgeon at Geisinger. However, its essential to get a medical diagnosis to rule out other conditions, like colon cancer or irritable bowel syndrome, and not rely on your own opinion about whats causing the problem.
What Is The Treatment For Combined Internal And External Hemorrhoids
There are two types of hemorrhoids, those that occur inside the anal opening and those that occur outside. In fact, the anatomy of hemorrhoids is rather complex. But, inside and outside are reasonable ways to think about hemorrhoids. Internal hemorrhoids are often asymptomatic. External hemorrhoids, however, are known for causing a wide variety of symptoms because they are located in a very sensitive area and are easily irritated.
When both internal and external hemorrhoids occur at the same time, the condition is known as combined hemorrhoids. Combined hemorrhoids can lead to symptoms of both conditions, as well as additional complications.
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How Are Hemorrhoids Treated
Your healthcare provider will create a care plan for you based on:
- Your age, overall health, and past health
- How serious your case is
- Whether you have internal hemorrhoids, external hemorrhoids, or both
- How well you handle certain medicines, treatments, or therapies
- If your condition is expected to get worse
- What you would like to do
The main goal of treatment is to reduce your symptoms. This may be done by:
- Sitting in plain, warm water in a bathtub several times a day
- Using ice packs to reduce swelling
- Using hemorrhoid creams or medicines inserted into your rectum
Your healthcare provider may also suggest that you add more fiber and fluids to your diet to help soften your stools. Having softer stools means you don’t have to strain during bowel movements. This reduces the pressure on your hemorrhoids.
Adding more fiber to your diet means eating more:
- Fruits
Tips to help you get the most from a visit to your healthcare provider:
Bad Smell Around The Anus
Hemorrhoids can cause feces and mucus to leak out of the anus, which may lead to a foul smell. There may also be other causes for this though, among them:
Anal fistula or anal abscess
An anal fistula can result in a bad smelling discharge from the anus. Another symptom of anal fistula is a mild, intermittent pain around the anus. A constant, throbbing pain that is even more pronounced when sitting down, having a bowel movement or when coughing can be the result of an anal abscess that often precedes an anal fistula.
Proctitis and anusitis
Proctitis and anusitis are conditions where the rectum and anus become inflamed. These conditions can cause bad-smelling discharge. Someone with these conditions will also likely experience a frequent urge to have a bowel movement, pain and a feeling a fullness in the rectum.
Fecal incontinence and anal cancer
A bad smell could be caused by fecal incontinence, which can be a sign of anal cancer. Seek prompt medical attention in all cases where anal cancer is suspected.
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What Are The Symptoms Of Internal Hemorrhoids
The first symptom of internal hemorrhoids is bleeding, either you see the blood that is bright red in the stool or on toilet paper. The other symptom is if the hemorrhoid prolapse and comes out.
Internal hemorrhoids are often painless but they can still cause a lot of problems even if cant feel them. Also known as inner hemorrhoids or internal piles, these conditions cause inflamed vascular structures inside the anal canal. Theyre located above the pectinate line and mostly painless.
Unlike external hemorrhoids, cant be seen from the outside since external hemorrhoids are located below the pectinate line. Internal hemorrhoids are covered with intestine cells and they can be harder to diagnose. External hemorrhoids, on the other hand, can be easily diagnosed since theyre not concealed inside the rectum, unlike the internal ones.
If you have internal hemorrhoids try this to get rid of them, this both clear hemorrhoid out and prevents them from coming again.
Make sure to watch the video too about symptoms of internal hemorrhoids!
There are some ways you can use to notice internal hemorrhoids and there sure are different options to treat them as well.
Also, read these related articles:
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How To Diagnose Internal Hemorrhoids
If you have any above-mentioned history, signs, and symptoms, consult your doctor for an early diagnosis, your doctor may do a Per Rectal examination or digital rectal examination to confirm the diagnosis of hemorrhoids. Apart from DRE, proctoscopy can help in diagnosis.
In order to rule out other diseases, you might need other tests such as sigmoidoscopy & colonoscopy.
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What Natural Home Remedies Soothe Or Cure Hemorrhoids
Hemorrhoid symptoms of pain and itching can be treated at home by doing the following.
Warm Sitz Baths
- Sitting in a few inches of warm water three times a day for 15 to 20 minutes may help decrease the inflammation of the hemorrhoids.
- It is important to dry off the anal area completely after each Sitz bath to minimize irritation of the skin surrounding the anus.
Dietary Changes
- Increased fluid intake and dietary fiber will decrease the potential for constipation and lessen the pressure on the rectum and anus during a bowel movement, minimizing further swelling, discomfort, and bleeding. Dietary fiber supplements also may help bulk up the stools
Stool Softeners
- Stool softeners may help. A health-care professional or a pharmacist are good resources to discuss their use.
Exercise
- Individuals with hemorrhoids should not sit for long periods of time and may benefit from sitting on an air or rubber donut available at most local pharmacies.
- Exercise is helpful in relieving constipation and in decreasing pressure on the hemorrhoidal veins. Individuals should be encouraged to have a bowel movement as soon as possible after the urge arises and not sit on the toilet for long periods of time. Once that urge passes, stools can become constipated and straining with a bowel movement may occur.
Treatments For External Hemorrhoids
External hemorrhoids are the more obvious and painful of the two types. Fortunately, there are plenty of methods to relieve the symptoms of discomfort if you have these small bumps around your anus.
Here are some methods to relieve external hemorrhoids:
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Internal Versus External Hemorrhoids
Internal hemorrhoids occur within the rectum. They arent usually visible and dont typically cause discomfort. They can bleed, however, and are the most common cause of bright red blood noted with bowel movements. They can also begin to interfere with bowel movements as they become larger.
Sometimes excessive straining can push an internal hemorrhoid outside of the anal opening. This straining can occur during a bowel movement but may be related to childbirth, heavy lifting, or certain sports activities. When an internal hemorrhoid falls outside the anus, it can cause significant discomfort and may bleed frequently.
External hemorrhoids occur in the sensitive anal region and often cause pain and bleeding with bowel movements. Because these hemorrhoids are exposed to external friction, they can also become itchy, irritated, and painful with routine activities such as sitting or walking.
Blood can sometimes pool in an external hemorrhoid and cause a clot . Thrombosed hemorrhoids can become extremely painful due to inflammation and swelling. You may notice a hard lump near the anal opening thats quite tender to touch.
Symptoms Of Prolapsed Internal Hemorrhoids
Hemorrhoids prolapse when their blood vessels swell and extend from their location in the rectum through the anus. In the anal canal, the hemorrhoid is exposed to the trauma of passing stool, particularly hard stools associated with constipation. The trauma can cause bleeding and sometimes pain when stool passes.
The presence of
- inflammation, and
- constant moisture
can lead to anal itchiness , and occasionally the constant feeling of needing to have a bowel movement. The prolapsing hemorrhoid usually returns into the anal canal or rectum on its own or can be pushed back inside with a finger, but falls out again with the next bowel movement.
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Symptoms Of Internal Hemorrhoids
Symptoms of internal hemorrhoids vary depending on their severity. Even as hemorrhoids worsen, you arent likely to experience pain due to the lack of nerve endings in the lower rectal area. Pain associated with hemorrhoids is typically caused by an associated condition, such as anal fissures or external hemorrhoids.
If you cant feel internal hemorrhoids, then how do you know theyre there?
In most cases, its because you begin to notice bleeding. You may see blood in your stool or notice it on the toilet paper when you wipe. Because this blood has a short path to travel outside the body, it should be bright red. You may not notice it right away if the bleeding is light.
While bleeding is the most common indicator of internal hemorrhoids, you may experience other symptoms if a hemorrhoid prolapses. This typically happens during a bowel movement, and in many cases, the tissue will go back in on its own. In other cases, you may have to push the tissue back in. In the case of Grade IV hemorrhoids, the tissue will remain prolapsed.
Its important to note that bleeding is also a common symptom of colorectal cancer, as well as internal hemorrhoids. Thats why we recommend you see a physician right away if you are experiencing any rectal bleeding, especially if it is accompanied by other suspect symptoms.
Only a qualified physician can accurately diagnose internal hemorrhoids.
What Causes Combined Hemorrhoids
The causes of internal and external hemorrhoids are the same, so it is not surprising that some people develop inflammation in both areas at once. Increased pressure on the anus and straining to have a bowel movement are thought to be the primary causes of hemorrhoid flare ups. This pressure may occur in a number of ways, including being due to:
- Pregnancy
- Other irregular bowel habits
- Spending too much time sitting on the toilet after a bowel movement
If the cause of inflamed hemorrhoids continues, the condition can worsen. Symptoms advance, and become difficult to ignore. Over time, complications including thrombosis of external hemorrhoids or prolapsing of internal hemorrhoids may occur.
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Who Is At Risk For Internal Hemorrhoids
The risk of hemorrhoids increases as your age advances because of the weakening of tissues supporting veins in the rectum and anal canal.It may also happen when there is increased intra abdominal pressure, which in turn increases pressure inside the rectum
For example,
Complications:
- Internal hemorrhoids can seldom cause complications,
- You can get anemia because of the constant chronic blood loss,
- Piles may get strangulated and cause immense pain
- A blood clot inside your piles may lead to Thrombosed Hemorrhoids, which should be managed effectively
- Piles may Prolapse
How Can I Treat Hemorrhoids At Home
Hemorrhoids often go away on their own without treatment. Symptoms like pain and bleeding may last one week or slightly longer. In the meantime, you can take these steps to ease symptoms:
- Apply over-the-counter medications containing lidocaine, witch hazel or hydrocortisone to the affected area.
- Drink more water.
- Increase fiber intake through diet and supplements. Try to obtain at least 20-35 grams of daily fiber intake
- Soak in a warm bath for 10 to 20 minutes a day.
- Soften stool by taking laxatives.
- Take nonsteroidal anti-inflammatory drugs for pain and inflammation.
- Use toilet paper with lotion or flushable wet wipes to gently pat and clean your bottom after pooping. You can also use a tissue or washcloth moistened with water.
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Procedures For Hemorrhoids Treatment
Some hemorrhoids can’t be managed with conservative treatments alone, either because symptoms persist or because an internal hemorrhoid has prolapsed. Fortunately, a number of minimally invasive hemorrhoid treatments are available that are less painful than traditional hemorrhoid removal and allow a quicker recovery. These procedures are generally performed in a surgeon’s office or as outpatient surgery in a hospital.
Band it. The most commonly used hemorrhoid treatment in the United States is rubber band ligation, in which a small elastic band is placed around the base of a hemorrhoid . The band causes the hemorrhoid to shrink and the surrounding tissue to scar as it heals, holding the hemorrhoid in place. It takes two to four procedures, done six to eight weeks apart, to completely eliminate the hemorrhoid. Complications, which are rare, include mild pain or tightness , bleeding, and infection. Other office procedures include laser or infrared coagulation, sclerotherapy, and cryosurgery. They all work on the same principle as rubber band ligation but are not quite as effective in preventing recurrence. Side effects and recurrence vary with the procedure, so consult your physician about what’s best for your situation.
Should I See A Doctor For Internal Hemorrhoid Symptoms
Symptoms of internal hemorrhoids require a visit to the doctor to rule out more serious causes and to get the fastest relief possible. While hemorrhoid symptoms typically arent an emergency medical situation, the symptoms should be concerning enough to encourage you to schedule an appointment sooner rather than later. Hemorrhoid symptoms are similar to the early symptoms of a number of more serious conditions, including colon cancer and inflammatory bowel disease.
It is important to note that some internal hemorrhoid symptoms do call for an immediate trip to see your doctor or visit to the emergency room. These includes acute or excessive bleeding, and prolapsed hemorrhoids that cannot be pushed back inside manually.
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