Hemorrhoids: Symptoms and Signs

Hemorrhoids are the most common cause of rectal and anal complaints.

It is important to remember that rectal bleeding or blood in the stool is never normal and while it may come from a relatively benign cause like hemorrhoids, more serious causes can be life threatening. These include bleeding from ulcers, diverticulitis, inflammatory bowel disease, and tumors. If rectal bleeding occurs, it is important to contact your health care professional or seek emergency medical care. This is especially important if the person is taking blood thinning medications.

Hemorrhoids Highlights

1. Hemorrhoids cause pain, severe itching, and difficulty sitting.
2. Consistent heavy lifting, being obese, or having other constant strain on your body can increase your risk of hemorrhoids.
3. Do not use soap to clean around your anus when treating a hemorrhoid.

Hemorrhoids are swollen veins located around the anus or in the lower rectum. About 50 percent of adults experienced the symptoms of hemorrhoids by the age of 50.

Hemorrhoids can either be internal or external. Internal hemorrhoids develop within the anus or rectum. External hemorrhoids develop outside of the anus. Hemorrhoids are also known as piles.

External hemorrhoids are the most common and most troublesome. Hemorrhoids cause pain, severe itching, and difficulty sitting. Fortunately, they are treatable.

Hemorrhoids Symptoms

Signs and symptoms of hemorrhoids may include:

• Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet
• Swelling around your anus
• A lump near your anus, which may be sensitive or painful (may be a thrombosed hemorrhoid)
• Extreme itching around the anus
• Irritation and pain around the anus
• Itchy or painful lump or swelling near your anus
• Fecal leakage
• Painful bowel movements
• Blood on your tissue after having a bowel movement

Although hemorrhoids are painful, they aren’t life-threatening and often go away on their own without treatment. If you have them often, you may develop symptoms of anemia, such as weakness and pale skin due to blood loss, though this is rare.

Hemorrhoid symptoms usually depend on the location.

Internal hemorrhoids. These lie inside the rectum. You usually can’t see or feel these hemorrhoids, and they rarely cause discomfort. But straining or irritation when passing stool can damage a hemorrhoid’s surface and cause it to bleed.

Occasionally, straining can push an internal hemorrhoid through the anal opening. This is known as a protruding or prolapsed hemorrhoid and can cause pain and irritation.

External hemorrhoids. These are under the skin around your anus. When irritated, external hemorrhoids can itch or bleed.

Thrombosed hemorrhoids. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus) that can result in severe pain, swelling, inflammation and a hard lump near your anus.

When to see a doctor

Bleeding during bowel movements is the most common sign of hemorrhoids. Your doctor can do a physical examination and perform other tests to confirm hemorrhoids and rule out more-serious conditions or diseases.

Also talk to your doctor if you know you have hemorrhoids and they cause pain, bleed frequently or excessively, or don’t improve with home remedies.

Don’t assume rectal bleeding is due to hemorrhoids, especially if you are over 40 years old. Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer. If you have bleeding along with a marked change in bowel habits or if your stools change in color or consistency, consult your doctor. These types of stools can signal more extensive bleeding elsewhere in your digestive tract.

Seek emergency care if you experience large amounts of rectal bleeding, lightheadedness, dizziness or faintness.

Grade of Hemorrhoids

When an internal hemorrhoid becomes inflamed, it can cause swelling. This in itself does not cause pain because there are no pain fibers attached to the veins above the pectinate line. Passing a hard stool can scrape off the thinned lining of the hemorrhoid causing painless bleeding. However, the swollen hemorrhoid can also cause spasm of the muscles that surround the rectum and anus causing pain, especially if they protrude or prolapse through the anus. A lump can be felt at the anal verge. Internal hemorrhoids can also thrombose (clot) leading to severe pain.

The inflamed hemorrhoid can leak mucus that can cause inflammation of the skin surrounding the anus causing burning and itching, known as pruritis ani. However, other causes of itching include yeast and other skin infections and parasites like pinworms. Most importantly, just as blood in the stool should not ignored in the stool because it mike be a sign of colon cancer, anal itching or bleeding should not be presumed to be due to hemorrhoids because it can be a sign of anal cancer tumor.

External hemorrhoids behave differently since they are covered by “regular skin” and have pain fibers associated with them. A thrombosed external hemorrhoid occurs when an underlying vein within the hemorrhoid clots off causing intense pain from the rapid stretching of the skin covering the hemorrhoid. A hard painful lump can be felt at the anus. External hemorrhoids can also result in excess skin tags that can be felt at the anal verge and can cause difficulties with cleaning after a bowel movement, leading to secondary skin infections.