If proper care is not taken, internal hemorrhoids may become worse over time.
When hemorrhoids occur inside of the anal canal, they are referred to as internal hemorrhoids. These hemorrhoids typically cannot be seen unless they prolapse, or protrude, outside of the anal opening.
- A hemorrhoid is a swollen or inflamed vein that lies within the rectum or in the perianal region.
- An internal hemorrhoid can develop when this cushioning tissue becomes thin due to aging, straining during bowel movements, or certain activities or conditions that place too much pressure on this area.
Hemorrhoid Classifications
There are four classifications of hemorrhoids.
- Grade 1, or first degree, hemorrhoids are located within the rectum and do not protrude outside of the anal opening.
- Grade 2, or second degree, hemorrhoids may protrude temporarily outside of the anus, especially during bowel movements, but retract back into the rectum spontaneously.
- Grade 3, or third degree, hemorrhoids protrude from the anus and must be pushed back into the rectum manually.
- Grade 4, or fourth degree, hemorrhoids prolapse further outside of the rectum and cannot be retracted spontaneously or manually. Grade 4 hemorrhoids are more likely to contain a blood clot, or thrombus.
Symptoms
Because there are very few pain nerves within the confines of the anal canal, most first or second degree internal hemorrhoids will not cause pain, even during a bowel movement. Bleeding may be the only symptom. The individual may see blood in the toilet after a bowel movement or as a streak on the stool. Fresh blood may be present on the toilet paper after wiping. Blood should not be ignored, even if the individual believes it could be a hemorrhoid, because more serious conditions can cause blood from the anus and require urgent treatment. Third and fourth degree hemorrhoids may cause more pain as they protrude outside of the anus. Other symptoms often associated with hemorrhoids include:
- Anal itching or burning
- Pressure or soreness in the anal area
- Bulging around the opening of the anus
Causes
The most commonly discussed causes of hemorrhoids are straining when having a bowel movement or sitting too long on the toilet. Hemorrhoids are more likely to occur in the elderly as the tissue in the anal region becomes thinner and weaker, allowing veins to bulge. Those who are obese or pregnant may be at a higher risk for developing internal hemorrhoids due to the extra pressure being placed on the region. A low-fiber diet and chronic bowel problems may also lead to the development of hemorrhoids.
Treatment
Hemorrhoids may go away on their own with a good diet, lots of fluids, exercise, and the use of special creams. It is important to avoid straining during a bowel movement. However, if no relief is seen in a week, medical treatment may be necessary. A physician with experience in treating hemorrhoids can provide options, which might include surgery or hemorrhoid banding.