Thomas P. Sokol, MD received his medical degree from the University of Health Sciences/The Chicago Medical School in 1980. He went on to his general surgical residency at Harbor/UCLA Medical Center and then to the Carle Clinic/ University of Illinois for Fellowship Training in Colon and Rectal Surgery.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
There are two types of nerves in the anal canal, visceral nerves (above the
dentate line) and somatic nerves (below the dentate
line). The somatic (skin) nerves are like the nerves of the skin and are capable
of sensing pain. The visceral nerves are like the nerves of the intestines and
do not sense pain,
only pressure. Therefore, internal hemorrhoids, which are above the dentate
line, usually are painless.
As the anal cushion of an internal hemorrhoid continues to enlarge, it bulges into
the anal canal. It may even pull down a portion of the lining of the rectum
above, lose its normal anchoring, and protrude from the anus. This condition is
referred to as a prolapsing internal hemorrhoid. In the anal canal, the
hemorrhoid is exposed to the trauma of passing stool, particularly hard stools associated with
constipation. The trauma can cause bleeding and sometimes pain when stool
passes. The rectal lining that has been pulled down secretes mucus and moistens the anus and the
surrounding skin. Stool also can leak onto the anal skin. The presence of stool
and constant moisture can lead to anal itchiness (pruritus ani), though
itchiness is not a common symptom of hemorrhoids. The prolapsing
hemorrhoid usually returns into the anal canal or rectum on its own or can be
pushed back inside with a finger, but it prolapses again with the next bowel
movement.
Less commonly, the hemorrhoid protrudes from the anus and cannot be
pushed back inside, a condition referred to as incarceration of the hemorrhoid.
Incarcerated hemorrhoids can have their supply of blood shut off by the
squeezing pressure of the anal sphincter, and the blood vessels and cushions can
die, a condition referred to as gangrene. Gangrene requires medical treatment.
For convenience in describing the severity of internal
hemorrhoids, many physicians use a grading system:
First-degree hemorrhoids:
Hemorrhoids that bleed but do not prolapse.
Second-degree hemorrhoids:
Hemorrhoids that prolapse and retract on their own (with or without bleeding).
Third-degree hemorrhoids:
Hemorrhoids that prolapse but must be pushed back in by a finger.
Fourth-degree hemorrhoids: Hemorrhoids that prolapse and cannot be pushed back in.
Fourth-degree hemorrhoids also include hemorrhoids that are thrombosed
(containing blood clots) or that pull much of the lining of the rectum through
the anus.
In general, the symptoms of external hemorrhoids are different than the
symptoms of internal hemorrhoids.
External hemorrhoids can be felt as bulges at
the anus, but they usually cause few of the symptoms that are typical of
internal hemorrhoids. This is perhaps, because they are low in the anal canal
and have little effect on the function of the anus, particularly the anal
sphincter. External hemorrhoids can cause problems, however, when blood clots
inside them. This is referred to as thrombosis. Thrombosis of an
external hemorrhoid causes an anal lump that is very painful (because the area
is supplied by somatic nerves) and often requires medical attention. The
thrombosed hemorrhoid may heal with scarring and leave a tag of skin protruding
from the anus. Occasionally, the tag is large, which can make anal hygiene (cleaning) difficult or
irritate the anus.
Rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Rectal bleeding may be moderate to severe and most bleeding comes from the colon, rectum, or anus. Common causes include anal fissures, hemorrhoids, diverticulitis, and more.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
Constipation is defined medically as fewer than three stools per week and severe constipation as less than one stool per week. Constipation usually is caused by the slow movement of stool through the colon. There are many causes of constipation including medications, poor bowel habits, low fiber diets, abuse of laxatives, hormonal disorders, and diseases primarily of other parts of the body that also affect the colon.
A skin tag is a small benign growth of skin that projects from the surrounding skin. Skin tags can vary in appearance (smooth, irregular, flesh colored, dark pigment, raised). Skin tags generally do not cause symptoms unless repeatedly irritated. Treatment for skin tag varies depending on the location on the body.
Anal itching is the irritation of the skin at the exit of the rectum, known as the anus, accompanied by the desire to scratch. Causes include everything from irritating foods we eat, to certain disease and infections. Treatment options include local anesthetics, vasoconstrictors, protectants, astringents, antiseptics, keratolytics, analgesics, and corticosteroids. If condition persists, a doctor examination may be needed to identify an underlying cause.
An anal fissure is a small tear or cut in the skin lining of the anus. Pain and/or rectal bleeding during bowel movements are common symptoms of anal fissures. Treatment involves increasing liquid intake, using stool softeners and avoiding foods that may not be well-digested.
Laxatives for treatment of constipation include over-the-counter preparations such as bulk-forming laxatives, stool softeners, lubricant laxatives, stimulant laxatives, saline laxatives, enemas and suppositories. Some over-the-counter laxatives are not recommended for patients with specific diseases or conditions. Some laxatives may have negative adverse effects if taken over long periods of time.
Portal hypertension is most commonly caused by cirrhosis, a disease in which results from scarring of a liver injury. Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from teh liver to the heart, and a parasitic infection called schistosomiasis.
Pregnancy can bring challenges like weight gain, stretch marks, varicose veins, heartburn, constipation, hemorrhoids, problems sleeping, and wondering if it is safe to have sex while pregnant. Learn how to manage and move through these challenges during pregnancy.
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