Internal & External Hemorrhoids

Internal Hemorrhoids

• The internal sphincter is responsible for regulating the frequency of bowel movements. Like a pregnant woman's cervix, which dilates to allow for birth, the internal sphincter also dilates for a bowel movement. If it doesn't dilate, there's no desire to push. When hemorrhoids develop, they begin internally. First- and second-degree hemorrhoids are internal. A first-degree hemorrhoid is characterized by a slight swelling of the anal canal lining, which a hard stool can cause to bleed. According to Robert Holt, the first-degree internal hemorrhoid might not be felt by the patient, but it can be detected in a medical exam. A second-degree hemorrhoid is characterized by "a small portion of the mucosa... and cushion... [protruding] at the anus during the course of a bowel movement," writes Holt. This protrusion goes back inside the anal canal once the bowel movement is complete.
  
  

External Hemorrhoids

• The hemorrhoid, which has started internally, becomes external in its third degree. A third-degree hemorrhoid is like a second-degree hemorrhoid, only instead of relaxing back into the anal canal after a bowel movement, it remains protruded, or outside of the anal opening. It must be carefully tucked back inside with the patient's fingers because when it is external, it gives the patient a dull achy sensation. The fourth-degree hemorrhoid (the final stage) is the externally protruding hemorrhoid that cannot be placed back inside the anal canal. According to Holt, this is also known as a "permanent bulge," and might cause a sufferer to avoid moving the bowels to avoid the pain of straining the hemorrhoid. A fourth-degree hemorrhoid can require emergency medical care if left untreated. An external hemorrhoid also can exist under the skin around the anus.
  
  

Symptoms

• Symptoms for first-degree hemorrhoids include pain-free bleeding during bowel movements, either in the toilet water or when wiping, but typically not integrated in the feces. For second-, third-, and fourth-degree hemorrhoids, a sufferer might experience continual anal itching, dull pain or ache in the sphincter, external swelling around the anal opening, uncontrollable feces seepage, a sensitive lump close to the anus and, of course, a hemorrhoid protrusion. An external hemorrhoid can form a blood clot that results in inflammation and serious pain.
  
  

Treatments and Personal Care

• Lifestyle modifications are the most commonly prescribed treatments for hemorrhoids. There are non-prescription creams and suppositories that can help in most cases, but simple things like soaking in a warm bath (several times a day), keeping the area very clean, using moistened wipes after bowel movements instead of dry paper, and applying ice packs to swelling are all things a sufferer can do reduce or eliminate a hemorrhoid. More intensive treatments include making incisions in external hemorrhoids, rubber band ligation (rubber bands to cut off circulation), injection (to shrink a hemorrhoid) and coagulation (lasers, heat, or infrared light used to shrink it). These treatments aren't surgery; surgical procedures are used after failed treatments, or if the hemorrhoid is very large.
  
  

Prevention

• According to the Mayo Clinic, "The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily." A diet high in fiber (fruits, vegetables and whole grains) is one of the most proactive preventive measures. Drinking six or more glasses of water (or liquids other than alcohol) a day also helps keep stools soft and passable. Exercise helps lessen vein pressure, as does refraining from sitting or standing for long stretches. Waiting to move bowels even past the urge to go can result in hardened feces, which are more difficult to move and can cause hemorrhoids. When moving bowels, don't strain (or stop breathing) while pushing.