Hemorrhoids Symptoms & Signs
Types of Hemorrhoids

 Hemorrhoids symptoms vary with the types of hemorrhoids. Visceral nerves, situated  above the dentate line, and somatic nerves, below the dentate line, are the two types of nerves in the anal canal which are known.

The visceral nerves are like the nerves of the intestines and do not sense pain, only pressure, while the somatic (skin) nerves are like the nerves of the skin and are capable of sensing pain. In most cases internal hemorrhoids, which are above the dentate line, are painless.

When the anal cushion of an internal hemorrhoid enlarges, it bulges into the anal canal and may even pull down a portion of the lining of the rectum above, lose its normal anchoring, and protrude from the anus.

This sign is called a prolapsing internal hemorrhoid. The hemorrhoids are exposed to the trauma of passing stool, particularly hard stools associated with constipation, situated in the anal canal.

Bleeding and sometimes pain when stool passes can be caused by the trauma and the rectal lining that has been pulled down secretes mucus and moistens the anus and the surrounding skin.

The presence of stool and constant moisture can lead to anal itchiness, known as pruritus ani and can leak onto the anal skin. Itchiness is not a common symptom of hemorrhoids, known in the medicine.

If the prolapsing hemorrhoid returns into the anal canal or rectum on its own or can be pushed back inside with a finger, it will prolapse again with the next bowel movement.

It may happen in some cases that the hemorrhoid protrudes from the anus and cannot be pushed back inside, but it is in extremely rare situations and refers to incarceration of the hemorrhoid.

Gangrene is a condition referred to incarcerated hemorrhoids and requires medical treatment and cure. It is when incarcerated hemorrhoids can have their supply of blood shut off by the squeezing pressure of the anal sphincter, and the blood vessels and cushions can die.

Many physicians use a grading system to describe the severity, effects, conditions and symptoms of internal hemorrhoids as well as dangers liked to prolapsed and strangulated hemroids : 

1.        First-degree hemorrhoids : bleed but do not prolapse.
2.        Second-degree hemorrhoids:   prolapse and retract on their own (with or without bleeding).
3.       Third-degree hemorrhoids:   prolapse but must be pushed back in by a finger.
4.         Fourth-degree hemorrhoids:   prolapse and cannot be pushed back in. Fourth-degree hemorrhoids also include hemorrhoids that are thrombosed , containing blood clots , or that pull much of the lining of the rectum through the anus.  

In summary, external hemorrhoids can be felt as bulges at the anus, but they usually cause few of the symptoms and signs that are typical of internal hemorrhoids. This means that external hemorrhoids’ symptoms differ from internal hemorrhoids’ ones.

External hemorrhoids can cause problems, however, when blood clots inside them and this situation is referred to as thrombosis. This occurs, because they are low in the anal canal and have little effect on the function of the anus, particularly the anal sphincter.

An anal lump, caused by thrombosis of an external hemorrhoid, can be very painful because the area is supplied by somatic nerves and often requires medical attention.

A healing could be with scarring and leave a tag of skin protruding from the anus for the thrombosed hemorrhoid. But if the tag is large, it can irritate the anus and make anal hygiene and cleaning difficult.