It is important to note that all people have hemorrhoidal tissue as part of their normal anatomy. Only in a minority of people do hemorrhoids become enlarged or otherwise symptomatic. Hemorrhoidal tissue lies within 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. Internal hemorrhoids are covered with a lining called mucosa that is not sensitive to touch, pain, stretch, and temperature, while external hemorrhoids are covered by skin that is very sensitive. When problems develop, these two types of hemorrhoids can have very different symptoms and treatments. Patients may experience symptoms caused by either internal or external hemorrhoids or both.
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Some patients will have long-standing complaints that are not attributable to hemorrhoidal disease. Other serious diseases such as anal and colorectal cancer should be ruled out by a consultation with physicians knowledgeable in evaluating the anal and rectal area. Painless rectal bleeding or prolapse of anal tissue is often associated with symptomatic internal hemorrhoids. Prolapse is hemorrhoidal tissue coming from the inside that can often be felt on the outside of the anus when wiping or having a bowel movement.
This tissue often goes back inside spontaneously or can be pushed back internally by the patient. The symptoms tend to progress slowly over a long time and are often intermittent. Internal hemorrhoids are classified by their degree of prolapse, which helps determine management:. Bleeding attributed to internal hemorrhoids is usually bright red and can be quite brisk. It may be found on the wipe, dripping into the toilet bowl, or streaked on the BM itself.
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Not all patients with symptomatic internal hemorrhoids will have significant bleeding. Instead, prolapse may be the main or only symptom.
