What are hemorrhoids?

Haemorrhoidal tissues are part of the normal anatomy of the distal rectum and anal canal. They originate either above the dentate line (internal) or below the dentate line (external). It is thought that as the overlying mucosa and skin becomes redundant, especially with straining and constipation, it prolapses into the anal canal. A small amount of prolapse results in bleeding or thrombosis but the patient becomes aware when the prolapse is extensive.

Hemorrhoids may result from straining to move stool. Other contributing factors include pregnancy, aging, chronic constipation or diarrhea, and anal intercourse.

Hemorrhoids are very common in both men and women. About half of the population have hemorrhoids by age 50. Hemorrhoids are also common among pregnant women. The pressure  of the fetus in the abdomen, as well as hormonal changes, cause the hemorrhoid vessels to enlarge. These vessels are also placed under severe pressure during childbirth. For most women, however, hemorrhoids caused by pregnancy are a temporary problem.

What are the symptoms of hemorrhoids?

Symptoms depend on the severity or degree of the haemorrhoid.

* Grade I painless rectal bleeding internal hemorrhoids don't prolapse at all.

* Grade II mild discomfort, bleeding internal hemorrhoids drop down with a bowel movement but then pop back up inside spontaneously.

* Grade III pain, bleeding, mucus discharge must be manually pushed back inside the anus.

* Grade IV pain, bleeding, possible thrombosis, and strangulation cannot be manually reinserted and are the most severe.
Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching (pruritus ani), have similar symptoms and are incorrectly referred to as hemorrhoids.
.In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.

Signs

The perineum may appear normal if there is a non-prolapsed internal haemorrhoid. These haemorrhoids are also difficult to feel on digital rectal examination.

The perineum may be macerated from chronic mucus discharge causing local irritation. In 3rd and 4th degree hemorrhoids  anal ectropion or perianal protuberance may be there in lax sphincters
Proctoscopy may reveal tissue with evidence of chronic venous dilatation, friability, mobility, and squamous metaplasia.

Bluish, soft bulging vessels covered by mucosa may be seen on examination if internal haemorrhoids have prolapsed.

 External haemorrhoids, bluish, soft bulging vessels covered by skin .
With external haemorrhoids, bluish, soft bulging vessels covered by skin .