Internal Hemorrhoids - Symptoms & Diagnosis
Internal Hemorrhoids
Internal hemorrhoids are located inside the anal canal and are often asymptomatic, making them difficult to detect. They are covered by mucous membrane or skin and are usually painless due to fewer pain-sensing nerves in the area. Hemorrhoids are a common condition, affecting almost 80% of adults at some point.
What do internal hemorrhoids look like?
One can also notice lumps that bulge outside the anus. These lumps are usually pinker and redder than the surrounding area & these are often referred to as prolapsed internal hemorrhoids. They can be bluish if thrombosed or blood has clotted inside them.
Causes for Internal Hemorrhoids
Blood vessels inside the anus stretch during straining or under pressure and may bulge and swell, causing hemorrhoids. Often it is due to:
- Increased straining during defecation
- Chronic diarrhea
- Sitting in the toilet for a longer time will also increase the pressure inside the lower rectum
- Being obese/pregnant. Pressure in the pelvis can limit drainage if blood out of normal hemorrhoidal tissues
- Eating less fiber food and reduced intake of water
- Anal intercourse
Symptoms of Internal Hemorrhoids
1. Internal hemorrhoids mostly have no noticeable symptoms.
2. Discomfort or irritation in the anal canal, mainly during or after bowel movements.
3. Painless bleeding through the anus during defecation.
4. Bright red blood in the toilet or on toilet paper after wiping.
5. Pink fleshy mass descending through the anus during straining, which may cause pain or irritation it may reduce on its own or require you manually reduce it back inside; always try!
6. Anal itching.
7. Mucous discharge.
Who is at risk for internal hemorrhoids?
The risk of hemorrhoids increases as your age advances because of the weakening of tissues supporting veins in the rectum and anal canal. It may also happen when there is increased intra abdominal pressure, which in turn increases pressure inside the rectum. For example:
- Pregnancy (most times resolves on its own after delivery)
- Any intra abdominal tumors
- Chronic liver disease
- A colonic growth or mass
- lifting heavy weights at work or at exercise
Complications:
- Internal hemorrhoids can seldom cause complications,
- Anemia can occur due to constant chronic blood loss.
- Piles may get strangulated and cause immense pain
- A blood clot inside your piles may lead to Thrombosed Hemorrhoids, which should be managed effectively
- Piles may prolapse
How to diagnose internal hemorrhoids?
If you have any above-mentioned history, signs, and symptoms, consult your doctor for an early diagnosis. In addition to DRE, proctoscopy, or sigmoidoscopy can assist in diagnosis. These procedures can be done awake or asleep, with or without preparation; the latter is generally preferred. Apart from DRE, proctoscopy or sigmoidoscopy can help in diagnosis. This can be done awake or asleep with or without preparation; with always better.
In order to rule out other diseases, you might need other tests such as sigmoidoscopy & colonoscopy.
Best treatments for Internal Hemorrhoids
There are various modes of management for internal hemorrhoids starting from home remedies to surgical methods
- Home remedies – which include lifestyle modifications such as a high fiber diet, drinking more water, warm sitz bath
- Nonsurgical management such as over the counter creams, analgesics, laxatives, and stool softeners
These may relieve the pressure inside the anal canal and make you feel better, and get rid of it
- Minimally invasive procedures such as
- Lord’s dilatation (dilatation of anal sphincter)
- Injection sclerosant therapy
- Barron’s banding (rubber band ligation)
- Cryotherapy
- Laser therapy
- Infrared coagulation
- Stapled hemorrhoidopexy
Newer methods such as harmonic scalpel therapy (using ultrasound)
- HAL – RAR Doppler-guided hemorrhoidal artery ligation & rectoanal repair proctoplast
- THD – transanal hemorrhoidal dearterialization. done visually or with ultrasound guidance.
How to prevent the Internal Hemorrhoids?
There are various modes of management for internal hemorrhoids starting from home remedies to surgical methods
- Keeping your stools soft may postpone the incidence of hemorrhoids. This can be achieved by:
- Eating high fiber foods
- Drinking more liquids with the fibre
- Adding fiber supplements to your regular diet.
- Avoid straining in the toilet, which may reduce your pressure inside the rectum
- Don’t postpone bowel movements – this may make your stools dry and hard to pass
- Stay active and do regular exercises
- Avoiding sedentary lifestyles
When to go see a doctor?
If you notice bleeding through the anus or any other above mentioned symptoms, like swelling or pain feel free to consult your doctor to make sure of the diagnosis. You should make an appointment to contact experts, since bleeding during bowel movements is not only due to hemorrhoids. Seek emergency care in case you have excess bleeding / acute pain or a change in bowel habits.