Haemorrhoids are vascular structures located in the smooth muscles of the anal canal that help control the elimination of stool. They are a normal part of the normal human anatomy and can be located at the junction where small arteries merge into veins. Haemorrhoids are full of blood vessels, support tissues, muscle, and elastic fibres and become Pathological Haemorrhoids, also known as Piles, when they are swollen or inflamed.
Technically, the word “Piles” refers to the condition when it is extremely painful and causes secondary problems and “Hemorrhoids” refers to it when swollen or simply the structure itself. However, these days the word “Piles” and “Hemorrhoids” are almost always used interchangeably.
Internal Haemorrhoids are located above the pectinate line, the dividing point between the upper ?and lower of the anus, and are covered with cells that are identical to those that line the rest of the ? intestines. External Hemorrhoids begin below the pectinate line and are covered with cells that resemble skin. Generally, hemorrhoids only become an issue if they begin to swell and cause itching, pain, or bleeding.
Even though the presence of hemorrhoids is normal in the human anatomy, most healthcare professionals consider them an abnormal occurrence because they are only truly present when caused by swelling or other problems.
External haemorrhoids that have no flow due to a blood clot in the vein are called Thrombosed Haemorrhoids. This type of hemorrhoid is not considered to be dangerous, however it can be quite painful and uncomfortable. With most thrombosed hemorrhoid cases the clot is eventually re-absorbed by the body and the symptoms resolve themselves in 2--3 days, however the swelling may take a couple weeks to completely disappear and a skin tag may remain after healing. If the external hemorrhoids is large and produces issues with proper hygiene, it may cause irritation to the surrounding skin and itchiness around the anus.
Internal haemorrhoids will usually cause a painless, bright red, rectal bleeding that happens during or after a bowel movement. Other symptoms of internal hemorrhoids may be mucous discharge, itchiness, fecal incontinence, or perianal mass if they slip forward through the anus. Internal haemorrhoids are usually extremely painful if the condition becomes thrombosed or necrotic. Internal hemorrhoids that become inflamed can cause swelling. This swelling is painless, however, because there aren’t any pain fibres connected to the veins located above the pectinate line. Passing a hard stool can also scrape the thinned lining of the hemorrhoid causing a painless bleeding. Swollen haemorrhoids can cause a spasm of the muscles surrounding the rectum and cause pain, especially if the swelling protrudes or prolapses through the anus. In this case, a lump can be felt at the anal verge.
Inflamed hemorrhoids can leak mucus that causes inflammation of the skin surrounding the anus. This inflammation may cause a burning and itching sensation, known as pruritis ani. Yeast or other skin infections and parasites cause the same itching sensation. Internal hemorrhoids are graded by their degree of prolapse below the pectinate line into the anal canal.
- Grade 1: Internal hemorrhoids bulge into the canal but does not prolapse or fall completely into it. These might bleed.
- Grade 2: Internal hemorrhoid protrudes past the anal verge while straining for a bowel movement or passing gas, and returns to its original internal position once the straining has subsided.
- Grade 3: Internal hemorrhoid may protrude past the anal verge without any straining and may require you to push inside manually.
- Grade 4: Internal hemorrhoid always stays in a protruding or prolapsed state and is at risk for thrombosis or strangulation if the anal muscles go into spasm.
Blood in stool should not be ignored. It might be a sign of colon cancer. Anal itching or bleeding should not be overlooked or presumed “normal” because of haemorrhoids; it may also be a sign of anal cancer tumour.