Internal & External Hemorrhoids: Top Causes & Symptoms

Hemorrhoid veins are blood vessels in the rectum that supply blood to the walls and muscles in the area. For a variety of reasons, these veins weaken and allow blood to pool which, in turn, causes them to swell and become inflamed. The resulting growths are called hemorrhoids, and they are a common condition that affects between 30 to 40 percent of people in the United States. Although anyone of any age can get hemorrhoids, they mostly affect people between the ages of 20 and 50.

There are two types of hemorrhoids: internal and external. The only difference between the two is the location. Though both types can cause issues if not treated properly, having one kind of hemorrhoid is not worse than having the other kind. How big they get and whether they become thrombosed are the two major factors in how much discomfort you feel. Here’s how to tell the difference between the two and reasons why they develop.
Internal and External Hemorrhoids

About Internal Hemorrhoids

Internal hemorrhoids form deep within the rectum. Because there are very few pain nerves in the area, they typically don’t cause any discomfort. In fact, most people with internal hemorrhoids don’t know they have them. The only sign of internal hemorrhoids may be bleeding, which may appear in the toilet, on toilet paper, or on the stool.

Another sign may be that the hemorrhoids grow big and heavy enough to prolapse through the anus. Since the anus does have quite a few pain-sensing nerves, this may cause intense discomfort. Visual inspection of the area may reveal pink, moist blobs of skin protruding from the anal hole. Mucus and tiny particles of stool may leak from the hemorrhoids and irritate the surrounding skin, leading to a condition called pruritis ani (burning and itching around the anus).

As the hemorrhoid heals, it will typically retreat back into the body. However, the growth can also be manually pushed back inside.

External Hemorrhoids

Conversely, external hemorrhoids develop around the anus and many times will appear as small lumps that feel hard to the touch. As noted previously, this area does have nerves so likely the first symptom you’ll experience is pain and discomfort. Like internal hemorrhoids, external ones may protrude through the anus. An added complication, though, is blood clots may form in the hemorrhoid and cause thrombosis, which is extremely painful but not life-threatening. This condition typically resolves after a few weeks, but your doctor may surgically remove the thrombosed hemorrhoid if the pain cannot be managed with medication or other complications develop.

Skin tags are another unfortunate consequence of external hemorrhoids. They may develop around the anal verge and make it challenging to keep the area clean after passing stool, which may cause you to develop a skin infection in addition to the hemorrhoids.

Hemorrhoid Causes

There are a number of factors that contributes to the weakening of the hemorrhoid veins and development of these uncomfortable growths. Some of these factors include:

  • Lack of fiber in diet – Dietary fiber helps pull water into the colon and soften stools, making them easier to pass. When a person doesn’t eat enough fiber, their stools are often hard which often leads to constipation and straining during bowel movements. This stress puts pressure on the hemorrhoid veins, weakening them over time and leading to the formation of hemorrhoids.
  • Obesity – There are a couple of reasons why obese people are more likely to get hemorrhoids. First, the excess weight puts immense pressure on pelvic and rectal area, weakening the veins and muscles there. Another issue is people who are obese are less likely to eat enough fiber or exercise regularly, which means they are more likely to experience constipation and diarrhea.
  • Pregnancy – A woman’s risk of getting hemorrhoids increases during the late term of pregnancy. Like with obese people, the excess weight from the baby puts pressure on the pelvis and anal region. Many women also get hemorrhoids after childbirth because of the tremendous amount of strain put on that area during labor.
  • Diarrhea and Constipation – The constant pressure to hole or expel stool may weakened the veins over time. Hemorrhoids can form whether the problem is chronic or acute. Studies also indicate that people who develop hemorrhoids also tend to have anal canals that are tighter than normal when not straining to pass bowels. Coupled with constipation, a higher resting anal canal tone can significantly increase the pressure in the rectum and cause the hemorrhoids to press against the sphincter muscle. As a person ages, these tissues weaken and increases the risk of hemorrhoids bulging and prolapsing through of the anus.
  • Spinal cord injury – This type of injury may damage the nerves in the rectum, which can make it difficult to determine when the bowels are full. While the rectum will automatically evacuate after a certain period of time, the pressure caused by holding waste in the body for longer than necessary often leads to hemorrhoids.
  • Rectal Surgery – Depending on the surgery, the rectum may be damaged in a way that makes it difficult to tell when it’s full like when a person as a spinal cord injury. The person may develop hemorrhoids as a result.
  • Colon Cancer – This cancer is sometimes confused with hemorrhoids since they share many of the same symptoms such as bleeding. However, colon cancer also causes pain in the lower abdomen, unexpected weight loss, and changes in bowel shape and movements. It’s essential that you get checked regularly to ensure your hemorrhoids aren’t cancer.
  • IBS (Irritable Bowel Syndrome) – As per National Digestive Diseases Information Clearinghouse (NDDIC), this condition affects 1 out of every 5 Americans, so it’s very common. It is a gastrointestinal disorder that causes frequent bouts of constipation and diarrhea, abdominal pain, cramping, and bloat. Because of the frequent bowel movements, you have a higher risk of getting hemorrhoids if you have this condition. However, it is a treatable disorder that can be brought under control by following your doctor’s treatment plan, taking any medications prescribed, reducing stress, and making healthy adjustments to your diet.
  • Chohn’s Disease – This is another inflammatory bowel disease. However, this condition is caused by an autoimmune disorder that causes the body to attack the tissues in the gastrointestinal track. The exact cause of the condition is unknown. However, it does cause frequent bouts of diarrhea as well as swelling and pain in the abdomen. As noted previously, persistent diarrhea increases your risk of getting hemorrhoids. Treatment for this disorder typically involves taking medication, getting regular exercise, and changing your diet. However, surgery may be required to treat severe cases.
  • Ulcerative Colitis – Also classified as an inflammatory bowel disease, ulcerative colitis causes some of the same symptoms as IBS and Crohns and for the same reason: inflammation in the bowels. People who have this disease experience bloody diarrhea, pain in the abdomen, and typically strain while passing stool. The symptoms vary from mild to severe, but the frequent bouts of diarrhea puts undue strain on your rectum and can cause hemorrhoids.

Symptoms of Hemorrhoids

The symptoms you experience will depend on the type of hemorrhoids you have. Since there are very few nerves deep in the rectum, you typically won’t experience any symptoms with internal hemorrhoids except for painless bleeding.

To confirm you have this type of hemorrhoids, you would need to be examined by a doctor who would perform a rectal exam using an anoscope. If there is any blood detected, the doctor may perform a sigmoidoscopy or colonoscopy to eliminate other conditions that may cause the bleeding such as cancer or colorectacl polyps.

External hemorrhoids, on the other hand, are fairly easy to diagnose. You may have this type of hemorrhoid if you begin exhibiting the following symptoms in or around the anus:

  • Itching or irritation
  • Swelling
  • Pain or discomfort (inability to sit comfortably)
  • One or more lumps that may be sensitive or painful
  • Swelling
  • Bleeding when passing stool
  • Leakage

If the hemorrhoid prolapses, you may feel a protrusion through the anus and the pain and irritation you experience may increase significantly.

How is Diagnosis Done

As noted previously, the doctor will perform a variety of tests or examinations to determine if you have hemorrhoids. Generally, the medical professional will begin by perusing your medical history and then conducting a physical exam. External hemorrhoids are often confirmed visually, especially if the growth has thrombosed (formed a blood clot).

To check for internal hemorrhoids, the doctor will perform a tactile examination by inserting a finger into the anal canal to feel for the growths. He or she may also use an anoscope or endoscope, which are plastic medical tubes that have lights on one end that illuminate the dark space.

If other certain symptoms present themselves, such as internal bleeding, the doctor may use a flexible sigmoidoscopy or perform a colonoscopy to eliminate other causes of internal growths and bleeding such as cancer or polyps, particularly if you’re a woman over the age of 50.

When to go for Medical Advice

Hemorrhoids are generally not serious and can easily be treated at home using homeopathic, over-the-counter, and prescription remedies. However, there are times when it’s essential to consult with a doctor.

  • The problem doesn’t clear up despite treatment
  • If you’re frequently or excessively bleeding from the rectum
  • The hemorrhoids are pain or uncomfortable
  • Your bowel movements look maroon or tarry (this is a sign of bleeding)
  • Dizziness, lightheadedness, or faintness after experiencing a bout of rectal bleeding
  • There is a marked change in your bowel habits

These symptoms may indicate a more serious problem with your rectum or gastrointestinal tract. Rectal bleeding should always be taken seriously because this is not a normal occurrence in this part of the anatomy. Although internal hemorrhoids are the most common source of this type of bleeding, other problems such as tumors, ulcers, inflammatory bowel disease, and diverticulits can also cause this symptom.

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