What is Internal Hemorrhoid?
Hemorrhoids, also known as piles, are a condition where the blood vessels in the anal canal become problematic, causing various symptoms. These tissues, naturally found within a layer in the anal canal, consist of flexible connective tissue, smooth muscle, and blood vessels with lots of connections between arteries and veins. This is why the bleeding from hemorrhoids is usually bright red. Hemorrhoids play a role in helping to control bowel movements by adding bulk to the anal canal. They typically appear in three specific places within the anal canal.
Hemorrhoids receive their blood supply from three key arteries, and their blood is drained away through veins that eventually connect to the iliac veins in the pelvic area. Hemorrhoids can be classified into four stages: Stage I hemorrhoids extend into the anal canal but don’t fall out; Stage II hemorrhoids fall out during a bowel movement but go back in on their own; Stage III hemorrhoids fall out and need to be pushed back in manually; Stage IV hemorrhoids fall out and cannot be pushed back in.
What Causes Internal Hemorrhoid?
Hemorrhoids are actually a normal part of our body and everyone has them. They help to keep our stool in place. Even when the muscles that control the opening of our anus are fully tightened, some leakage can still occur. That’s where hemorrhoids come in. When we strain, sneeze, or exert ourselves, these hemorrhoids – or vascular cushions – swell up temporarily and completely close off the anus, preventing any stool from leaking out. Once we’re done straining, the hemorrhoids go back to their normal size.
Risk Factors and Frequency for Internal Hemorrhoid
The exact number of people who have hemorrhoidal disease is tough to calculate because many people don’t see a doctor for it. However, it’s estimated that this issue is the third most common reason for outpatient gastrointestinal doctor visits in the U.S., with around 4 million people visiting the doctor or emergency department each year for it. Roughly 75% of Americans will have hemorrhoid symptoms at some time in their lives. Although the exact percentage range of people with hemorrhoidal disease is varied, with studies suggesting anywhere between 4% to 40%. The condition seems to be most common among white individuals aged 45 to 65 and wealthier people. But, it’s important to note that this might be because these groups typically have better access to healthcare.
- Hemorrhoidal disease is hard to measure because many people don’t see a doctor for their symptoms.
- It’s thought to be the third most common reason for outpatient gastrointestinal visits in the U.S.
- About 4 million people see the doctor or go to the emergency department for it each year.
- Approximately 75% of Americans will have hemorrhoid symptoms at some point.
- Studies suggest that between 4% and 40% of people have hemorrhoidal disease, but the exact percentage is uncertain.
- It seems most common among white individuals between the ages of 45 and 65 and wealthier people. But, this could be because these groups generally have better access to healthcare.
Signs and Symptoms of Internal Hemorrhoid
It’s quite common for people who aren’t medical experts and even some doctors who are unfamiliar with the condition, to mislabel certain anorectal ailments as “hemorrhoids”. However, there are various other illnesses in the same area that are benign but different, such as fissures, fistulas, and abscesses. If a person has symptomatic internal hemorrhoids, they could experience symptoms like itching, bleeding, pain, a burning sensation, prolapse (tissue slipping out of place), mucus discharge, moisture, swelling or difficulty with cleaning the area around their anus.
A person with hemorrhoids might feel like they’re sitting on a foreign object. We typically think of internal hemorrhoids, which start above an area called the dentate line, as not causing actual pain. However, some patients with internal hemorrhoids do report pain, but it’s possible what they’re feeling is itchiness or a burning sensation.
If there’s severe pain, it might be because of an issue like thrombosed or strangulated internal hemorrhoids, in which case it’s a good idea to check for other sources of the pain like fissures or damaged skin around the anus. Hemorrhoid bleeding is usually bright red, and often occurs at the end of bowel movements because the stool can injure the swollen hemorrhoids.
- Feeling like sitting on a foreign object
- Itching, bleeding, pain, burning
- Internal hemorrhoids might not cause actual pain
- Bleeding often occurs at the end of bowel movements
People can feel fullness, a need to poop, or feel as though they haven’t fully emptied their bowel. If the internal hemorrhoids are prolapsing or slipping out of place, that can cause these feelings. If the hemorrhoids are fully prolapsing, a person might feel a lump and may have issues with anal leakage or a feeling of being wet. It would be useful to find out if there are certain things that bring on these symptoms, such as constipation, diarrhea, heavy lifting, chronic coughing, or not having enough fiber or water in their diet.
A physical exam might reveal signs of liver disease, Chronic Obstructive Pulmonary Disease (COPD), and symptoms of constipation like a bloated belly or fecal impaction. An anorectal exam, which is usually done while the patient is in the prone jackknife position, allows for the best view of the perineum and anus but can also be done while the patient is on their side or in the lithotomy (gynecological) positions. External hemorrhoids, skin tags, internal hemorrhoids that are prolapsing, fissures, fistulas, abscesses are things that might show up in the exam. A detailed examination is required to find any masses, indurations (areas that are hardened), tenderness. The doctor also checks sphincter tone, masses, pain, and abscesses using a digital examination.
Testing for Internal Hemorrhoid
If someone has hemorrhoids, it’s necessary to use a technique called anoscopy to evaluate them properly. A side-viewing instrument called an anoscope is the best tool for viewing internal hemorrhoids, especially if they’ve slipped down (or prolapsed) into the anus area. This gives a clear idea of the size of the hemorrhoids. Disposable plastic anoscopes are handy because they’re clear, letting the doctor see the whole anal canal at once.
During the exam, the patient will need to strain, as this helps to show how far the hemorrhoids have prolapsed. In some cases, having the patient sit on a toilet and strain can provide a more accurate picture of the prolapse degree.
Additional tests like a flexible or rigid proctoscopy might be necessary, especially if the patient is experiencing alarming symptoms like bleeding, weight loss, changes in bowel movements, or anemia. In such cases, a comprehensive examination of the large intestine called colonoscopy could also be considered.
Treatment Options for Internal Hemorrhoid
The treatment for hemorrhoids depends on symptoms. Options include medications, office-based procedures, and surgery. The first line of treatment involves a high-fiber diet, water intake, exercise, and regular bathroom schedule. Over-the-counter stool softeners can help. Avoid straining, excessive wiping, and take sitz baths for itching, pain, or burning. Office-based treatments include rubber band ligation, injection sclerotherapy, and infrared coagulation. Surgical removal may be necessary if non-surgical treatments fail or if hemorrhoids are large. Different surgical procedures have different advantages. The choice of procedure depends on the patient’s case.
What else can Internal Hemorrhoid be?
These medical terms might sound complicated, so let’s break them down:
- External hemorrhoids: These are lumps that occur around the anus, often causing pain and discomfort.
- Perianal abscess: This is a condition in which a pocket of pus develops near the anus, causing pain and inflammation.
- Fistula disease: This is when an abnormal tunnel forms between the intestines and skin near the anus, resulting in a persistent, recurring infection.
- Anal/rectal cancer: This is a serious disease where cancerous cells form in the tissues of the anus or rectum.
- Anal fissure: This is a small tear in the thin, moist tissue lining the anus, often causing painful bowel movements.
Each of these conditions can be serious, so it’s important to see a doctor if you’re experiencing any unusual or persistent symptoms in the anal or rectal region.
What to expect with Internal Hemorrhoid
The outlook for internal hemorrhoids is generally positive. They usually get better with routine medical treatment. However, there’s a 10 to 50% chance of them returning within 5 years with this sort of treatment. On the other hand, if surgically removed, the chance of them returning is below 5%.
Possible Complications When Diagnosed with Internal Hemorrhoid
The main issue linked to internal hemorrhoids is bleeding. However, there can be numerous complications following various treatments for hemorrhoids. Complications such as delayed bleeding, severe pain, open sores, and rapid and severe infection can all occur after procedures for treating hemorrhoids. In the specific case of rubber band ligation, delayed bleeding can occur roughly 1% of the time. Serious infections from rubber band ligation are more prone to develop in individuals with weakened immune system. Symptoms include fever, swelling around the anal area, and pain. Immediate treatment involving antibiotics and removal of dead tissue is needed, and in some instances, a procedure to divert waste from the colon and out through an opening in the abdominal wall might be necessary.
Furthermore, patients can experience difficulties urinating after surgical treatments for internal hemorrhoids, which can occur in about 15% of patients. This is more likely with aggressive fluid hydration and pain. Anal narrowing, an uncommon side effect of hemorrhoid surgery, can be treated with anal dilation and changes to dietary habits.
Common Side Effects:
- Bleeding
- Delayed hemorrhage
- Severe pain
- Open sores
- Rapid and severe infection
- Swelling around the anal area
- Difficulties with urination
- Anal narrowing
