A briefing on Internal Hemorrhoids

Hemorrhoids are anatomically defined as, "the blood vessel-filled tissue at the meeting of the anus and the rectum." When used in the popular sense of, "I have hemorrhoids," the word refers to vein varicosities in the hemorrhoids, which is to say swollen, knotted and/or enlarged veins in the tissue at the meeting of the rectum and the anus. Perianal hematoma, which is bruising caused by ruptured veins within the perianal tissue, can be mistaken for and misdiagnosed as hemorrhoids. The treatment for hemorrhoids is different than the treatment for perianal hematoma. This article will focus on internal hemorrhoids.

There are two types of hemorrhoids, internal and external. For our purposes, we shall define internal hemorrhoids as, "varicosities (swollen, knotted and/or enlarged veins) in the hemorrhoid tissue inside the rectum."

Hemorrhoid tissue inside the rectum drains the area of the superior rectal arteries. The tissue in this area does not have pain receptors. Consequently, internal hemorrhoids typically go unnoticed unless irritated, as which time they may bleed. Sometimes other rectal problems are incorrectly diagnosed as hemorrhoids. Conditions that can create hemorrhoid-like symptoms include abscesses, anal irritation, itching or melanoma, fistulae, and fissures.

Internal hemorrhoids are not life threatening or dangerous. Mild hemorrhoid symptoms usually resolve within a few days. Many people with hemorrhoids do not manifest symptoms. For many, their first sign of hemorrhoids is blood on the feces, toilet paper or in the bowl. When a swollen internal hemorrhoid is forced outside the anus, usually during defecation, it is called a protruding hemorrhoid. With hemorrhoids, rubbing and cleaning of the anus makes matters worse. The irritation can lead to a cycle of symptoms.

Without proper treatment internal hemorrhoids can worsen to prolapsed hemorrhoids or even strangulated hemorrhoids. A prolapsed hemorrhoid is a protruding internal hemorrhoid that remains outside the anus even when the anus is closed. Note the progression: from an internal hemorrhoid to a protruding hemorrhoid to a prolapsed hemorrhoid.

The final stage is a strangulated hemorrhoid. This happens when the sphincter, trying to rid itself of the irritant of the prolapsed hemorrhoid, goes spastic. The muscle spasm cuts off the blood supply to the veins in the hemorrhoid, strangling it.

The Banov grading system is the most common means of classifying hemorrhoids by severity. Under the Banov system, hemorrhoids are ranked on a scale of 1 to 4. A grade 1 hemorrhoid does not protrude - that is, it is a true internal hemorrhoid. Grade 2 hemorrhoids protrude outside of the anus when defecation is taking place, but spontaneously reduce with the removal of muscle tension and withdraw to an interior position. Grade 3 hemorrhoids must be manually reduced (squeezed) once defecation is complete to allow withdraw inside the anus. Grade 4 hemorrhoids require surgery as they are external to the body and cannot be manually reduced.

Internal hemorrhoids can be caused by chronic constipation, diarrhea, portal hypertension, obesity, poor muscle tone, poor posture and pregnancy. Excessive consumption of alcohol or caffeine is thought to at least aggravate hemorrhoids.

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