Hemorrhoids (Piles) (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Bhupinder Anand, MD
In this Article
What are the signs and symptoms of a hemorrhoid?
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Hemorrhoids are the most common cause of rectal and anal complaints. The most common complaint is painless bleeding, anal itching, pain, swelling and feeling a lump at the anus are all associated with an inflamed hemorrhoid.
It is important to remember that rectal bleeding or blood in the stool is never normal and while it may come from a relatively benign cause like hemorrhoids, more serious causes can be life threatening. These include bleeding from ulcers, diverticulitis, inflammatory bowel disease, and tumors. If rectal bleeding occurs, it is important to contact your health care professional or seek emergency medical care. This is especially important if the person is taking blood thinning medications.
When an internal hemorrhoid becomes inflamed, it can cause swelling. This in itself does not cause pain because there are no pain fibers attached to the veins above the pectinate line. Passing a hard stool can scrape off the thinned lining of the hemorrhoid causing painless bleeding. However, the swollen hemorrhoid can also cause spasm of the muscles that surround the rectum and anus causing pain, especially if they protrude or prolapse through the anus. A lump can be felt at the anal verge. Internal hemorrhoids can also thrombose (clot) leading to severe pain.
The inflamed hemorrhoid can leak mucus that can cause inflammation of the skin surrounding the anus causing burning and itching, known as pruritis ani. However, other causes of itching include yeast and other skin infections and parasites like pinworms. Most importantly, just as blood in the stool should not ignored in the stool because it mike be a sign of colon cancer, anal itching or bleeding should not be presumed to be due to hemorrhoids because it can be a sign of anal cancer tumor.
External hemorrhoids behave differently since they are covered by "regular skin" and have pain fibers associated with them. A thrombosed external hemorrhoid occurs when an underlying vein within the hemorrhoid clots off causing intense pain from the rapid stretching of the skin covering the hemorrhoid. A hard painful lump can be felt at the anus. External hemorrhoids can also result in excess skin tags that can be felt at the anal verge and can cause difficulties with cleaning after a bowel movement, leading to secondary skin infections.
Medically Reviewed by a Doctor on 10/1/2013
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