External and Internal Hemorrhoids

There are two different types of hemorrhoids recognized by doctors: external and internal.  Internal hemorrhoids develop over the dentate line inside the rectum.  External hemorrhoids are underneath the dentate line and reside outside of one’s anal canal.

The dentate line is what separates the upper part of one’s anal canal and the lower and is used by medical professional to distinguish between external and internal hemorrhoids.

Prolapsed Internal Hemorrhoids

Internal hemorrhoids generally can’t be seen unless they are beneath one’s anal canal.  This type of hemorrhoid is called prolapsed.  There are fewer nerves in prolapsed internal hemorrhoids than there are in external hemorrhoids which generally makes them less painful.  If they become irritated, however, they may bleed.

Hemorrhoid grade levels are used by doctors to categorize the various types of hemorrhoids.  Each grade level represents an increase in the Piles severity.  The severity of the different hemorrhoids is based on the amount of bleeding and whether the hemorrhoid is prolapsed or not.  All hemorrhoids, even a Grade I hemorrhoid, may bleed.

Hemorrhoid Grade Levels

Hemorrhoids are usually classified into four grades by doctors:

Grade 1 Hemorrhoids- are not prolapsed and bleed internally.  They can’t be seen beneath the anus.

Grade 2 Hemorrhoids- may prolapse and drop if the person strains and forces their bowel movements.  These hemorrhoids, however, do go back within the anus by themselves after the straining has stopped and bowel movements have ended.  These hemorrhoids haven’t yet reached a prolapsed state.

Grade 3 Hemorrhoids- straining during bowel movements can cause the hemorrhoid to prolapse.  When bowel movements end they don’t return to within the anus on their own.  However they can be pushed back in and will stay.

Grade 4 Hemorrhoids- this type of hemorrhoid protrudes on its own and is the most severe type.  Once they are on the exterior of the anus they remain on the outside.  They can’t be pushed back in.  Often they are thrombosed, meaning they become engorged as a result of a blood clot.  This can be quite painful.

Thrombosed External Hemorrhoids

Having this type of hemorrhoid makes bowel movements and even standing or sitting painful.  Inflamed never endings can result in itching as well.  When blood clots develop in external hemorrhoids they are considered thrombosed.  Blood clots can form quite suddenly.

As you have learned there are several different hemorrhoid grade levels, each one increasing in severity and potential pain levels.  For more severe hemorrhoids, surgery may be necessary.

External hemorrhoids can be very painful.  Fortunately there are several different treatment options available to alleviate this painful condition which occurs when the veins surrounding the anus and rectum become inflamed.  Increased pressure to one’s external hemorrhoidal veins is what causes external hemorrhoids.

External Hemorrhoids Causes and Symptoms

This increased pressure can be caused by several factors, including poor bowel habits, a low fiber, high fat diet, obesity, cirrhosis, anal sex, chronic diarrhea or constipation, aging and pregnancy.

Although internal hemorrhoids generally aren’t very painful, this is not the case with external hemorrhoids.  Symptoms may include anal itching, bleeding, painful bowel movements, burning sensations and irritation.  A thrombosed external hemorrhoid can also develop, which is a hard lump surrounding the anus and is the result of blood clots forming.

External Hemorrhoid Treatment Options

External hemorrhoid treatments include taking several warm sitz baths daily, applying ice packs, increasing fiber and fluids to one’s diet, over-the-counter medications such as ointments and topical creams and stool softeners.  If trying a topic hemorrhoid cream, be sure the cream contains an anesthetic like lidocaine, benyl alcohol or benzocaine.  This will help to reduce irritation and pain.

Another hemorrhoid treatment option to try is a pharmaceutical ointment.  Tucks and Preparation H are two well-known ointments available over-the-counter.  These include chemical agents known as vaso-constrictors which help to prevent blood clots from forming and also help to reduce swelling.  The mild anesthetic effects of these ointments can also provide relief from pain and itching fairly quickly.  If you decide to try a hemorrhoids ointment, be sure that it contains epinephrine or ephedrine sulfate.

Astringents such as aloe vera and witch hazel gels can also help to reduce external hemorrhoid symptoms and help to provide fast relief.  Often these treatments will improve one’s symptoms in a few days.

The use of ice cubes and warm sitz baths also can be effective in reducing bleeding and swelling of the hemorrhoid.  Salt and ice cubes can also be added to a sitz bath.

If these home hemorrhoid treatments are not successful, surgery may become necessary.  Surgical options include sclerotherapy, hemorrhoid banding procedures, hemorrhoid laser treatment or a hemorrhoidectomy.

Prevention of External Hemorrhoids

To prevent external hemorrhoids from occurring, good bowel habits should be employed, including emptying ones bowels right away and keeping stool soft to allow it to easily pass through.  Eating a healthy, high fiber diet and implementing a good exercise routine, which includes walking, are also very helpful and will help to reduce the risk of constipation and the development of external hemorrhoids.

There are many hemorrhoid treatments available, ranging from surgery and medical treatments to simple lifestyle changes such as alterations to ones bowel and diet habits.  Usually only very painful or large hemorrhoids require surgical or other medical treatments.

Nonsurgical treatment procedures are used to help reduce the supply of blood flowing to a hemorrhoid which will cause the hemorrhoid to go away or shrink.  Scar tissue following the procedure helps to prevent the development of more hemorrhoids and helps with supporting anal tissue.

These types of procedures are also referred to as fixative procedures and include rubber band ligation (tying hemorrhoids off using a rubber band) and coagulation therapy through the use of electric current, lasers or heat to produce scar tissue.

Hemorrhoidectomy, or the removal of hemorrhoids through surgery, is sometimes used to remove either several small hemorrhoids from one area or large internal hemorrhoids.  Surgery may also be necessary if other types of hemorrhoid treatments have not been able to control the bleeding.

Best Hemorrhoid Treatment

At times a combination of surgery and fixative procedures may prove to be the most effective at treat hemorrhoids.  Better long term results may result from hemorrhoidectomy rather than fixative procedures, however surgery involves recovery times that are longer, is more expensive, and is often more painful and can result in more complications.  For individuals in poor health or over the age of 70, fixative procedures generally are the hemorrhoid treatment of choice.

Hemorrhoids Treatment at Home

There are several home hemorrhoid treatment options available that can be tried.

* Sitz Baths

Taking several 15-20 minute baths daily with warm water can help to decrease hemorrhoid inflammation.  The anal area should be dried off thoroughly following the bath.  This will help to minimize skin irritations around the anus.

* Changes to Diet

Increasing fiber and fluid intake reduces the likelihood of developing constipation and allows reduces the amount of pressure for the anus and rectum during bowel movements.  This helps to minimize additional bleeding, discomfort and swelling.  Stools can also be bulked up through the use of dietary fiber supplements.

* Stool Softeners

At times stool softeners can be helpful.  However, once hemorrhoids have developed, liquid stools can cause infection and inflammation in the anus.  Consult with your physician or other health care professional.
* Changes in Activity

It is not a good idea for individuals suffering from hemorrhoids to sit for extended amounts of time.  Sitting on rubber or air donuts, which can be purchased from many local pharmacies, can help to alleviate some pain.

It is also a good idea to engage in some physical exercise, which can help to reduce pressure on one’s hemorrhoidal veins and also help to reduce constipation.  Bowel movements should be performed as soon as one can.  If delayed, constipation can occur.

* Over-the-Counter Hemorrhoid Medications

There are many hemorrhoid suppositories, ointments and creams that are available for purchase over the counter.  They can help with hemorrhoid symptom relief but will not cure hemorrhoids.  A corticosteroid or numbing medication is often contained in the medications to help with decreasing swelling and inflammation.

Medical Hemorrhoid Treatments

* Prolapsed Internal Hemorrhoids

These hemorrhoids can often be pushed into the anus again. However, if the hemorrhoids stay swollen and outside the anus, infections can occur.  Surgery may become necessary.

* Thrombosed Hemorrhoids

These hemorrhoids are often quite painful.  They generally are hard and can’t be pushed back inside in.  With these situations, the clot inside the hemorrhoid is removed through making a small incision.

* Surgery

For persistent hemorrhoidal pain and bleeding there are several surgical options that are available.

Rubber band ligation on internal hemorrhoids is a procedure that can be performed at the doctor’s office.  A few tight rubber bands are placed by the surgeon around the hemorrhoidal vein’s base.  The surgeon places a couple of tight rubber bands around the base of the hemorrhoidal vein which cuts off the blood supply.

Sclerotherapy is a procedure where the hemorrhoid is injected with a chemical to cause scarring.

Laser therapy is used to harden and scar internal hemorrhoids.

Stapled hemorrhoidectomy is a new surgical procedure for the treatment of hemorrhoids.  The hemorrhoids themselves are not removed.  Instead the expanded and abnormally lax hemorrhoidal supporting tissue is removed.  This is much quicker and less painful procedure than traditional hemorrhoidectomy is.

Hemorrhoidectomy surgery is performed in an operating room  with sedation. This form of treatment involved the removal of the entire hemorrhoid.  This treatment is very aggressively and greatly reduces the chances of hemorrhoids reoccurring.  However complication rates also are increased.

Whatever form(s) of hemorrhoid treatment are used, a change in diet to increase roughage and fluids is recommended.