Hemorrhoids are a common and unpleasant condition that affects many people. In this article, we will look at the different types of hemorrhoids, their symptoms, causes, and treatment methods.

 

1. External hemorrhoids

 

External hemorrhoids are a common problem. They develop under the skin around the anus. They form when the veins in the area become enlarged and inflamed - this leads to swelling and pain. Usually, external hemorrhoids cause various symptoms that can vary in intensity.

 

Causes of occurrence

 

External hemorrhoids can be caused by a variety of factors. The most common causes include:

  • Excessive straining during bowel movements;
  • Prolonged sitting on the toilet;
  • Constipation or diarrhea;
  • Pregnancy and birth;
  • Obesity;
  • Lifting heavy objects.

 

Symptoms

 

Symptoms of external hemorrhoids can be different, depending on the severity of the condition. The most common symptoms include:

  • Pain and discomfort, especially when sitting;
  • Itching and irritation around the anus;
  • Swelling and inflammation;
  • Hard lumps around the anus;
  • Bleeding, especially after bowel movements.

 

Diagnostics

 

Diagnosing external hemorrhoids is usually easy. The doctor can perform a visual examination of the anus and rectum. In some cases, a digital rectal examination may be necessary to assess the size and location of the hemorrhoids.

 

Treatment

 

Treatment of external hemorrhoids may involve different approaches, depending on the severity of the condition. Mild cases are often treated with home remedies, while more severe cases may require medical intervention.

 

Home remedies

The most commonly used home remedies include:

  • Application of cold compresses to reduce swelling;
  • Warm sitz baths for pain relief;
  • Use of creams and ointments containing hydrocortisone;
  • Increasing fiber in the diet to prevent constipation;
  • Drinking lots of water.

 

Drinking water

 

Medical procedures

In more severe cases, medical intervention may be necessary. Possibilities include:

  • Minimally invasive procedures such as rubber band ligation or sclerotherapy;
  • Surgical removal of hemorrhoids ( hemorrhoidectomy );
  • Laser therapy.

 

2. Internal hemorrhoids

 

Internal hemorrhoids are often not as painful as external hemorrhoids. They are located inside the rectum and are usually not visible to the naked eye. Although they do not cause pain, they can lead to serious complications if not treated properly.

 

Causes of occurrence

 

Internal hemorrhoids develop due to increased pressure on the veins in the rectum. This pressure can be a result of:

  • Constipation and straining during bowel movements;
  • Diarrhea;
  • Prolonged sitting on the toilet;
  • Pregnancy, which increases the pressure in the pelvic area;
  • Obesity;
  • Genetic predisposition.

 

Symptoms

 

Internal hemorrhoids can go unnoticed for a long time because they rarely cause pain. Symptoms of internal hemorrhoids are:

  • Bleeding during bowel movements: The most common symptom of internal hemorrhoids is painless bleeding during or after a bowel movement. The blood is usually bright red;
  • Prolapse: In more advanced cases, internal hemorrhoids can protrude outside the anus, which can cause pain and discomfort;
  • Mucous discharge: Internal hemorrhoids can lead to mucous discharge, which can cause irritation and itching around the anus;
  • Sensation of fullness: Fullness or pressure may be felt in the rectum.

 

Diagnostics

 

Diagnosing internal hemorrhoids often requires an examination by a specialist. Diagnostic methods include:

  • Anoscopy: Using a small lighted device to view the inside of the rectum;
  • Sigmoidoscopy: A flexible tube instrument with a camera is used to view the lower part of the colon and rectum;
  • Rectal exam: The doctor may perform a digital rectal exam to evaluate the presence of internal hemorrhoids.

 

Treatment

 

Treatment of internal hemorrhoids depends on the severity of the symptoms and the degree of prolapse. Mild cases can be treated with home remedies, while more severe cases may require medical intervention.

 

Home remedies

Home treatment for internal hemorrhoids includes:

  • Increasing fiber intake to prevent constipation;
  • Drinking enough water;
  • Using creams and suppositories to relieve symptoms;
  • Avoiding excessive straining during bowel movements.

 

Medical procedures

In more serious cases, medical interventions may be required:

  • Rubber band ligation: Placing a rubber band around the base of the hemorrhoid to cut off its blood supply;
  • Sclerotherapy: Injection of a solution that causes the hemorrhoid to shrink;
  • Infrared Coagulation: Using infrared light to coagulate and shrink the hemorrhoid;
  • Surgery: In rare cases, surgical removal of hemorrhoids ( hemorrhoidectomy ) may be necessary.

 

Prolapsed hemorrhoids

 

3. Prolapsed hemorrhoids

 

Prolapsed hemorrhoids are internal hemorrhoids that have protruded outside the anus. This condition can be extremely painful and often requires medical intervention. Prolapsed hemorrhoids can vary in severity and cause different symptoms.

 

Causes of prolapse

 

Prolapsed internal hemorrhoids can be caused by a variety of factors, including:

  • Prolonged and severe constipation;
  • Frequent straining during bowel movements;
  • Prolonged diarrhea;
  • Pregnancy and birth;
  • Heavy physical exertion;
  • Rectal muscle weakness.

 

Degrees of prolapse

 

Prolapsed hemorrhoids can be classified into different grades depending on the severity of the condition:

  • First degree: Hemorrhoids do not extend beyond the anus;
  • Second degree: Hemorrhoids protrude outside the anus during defecation, but return on their own;
  • Third degree: Hemorrhoids protrude outside the anus during defecation and must be retracted manually;
  • Fourth degree: Hemorrhoids are permanently outside the anus and cannot be retracted.

 

Symptoms

 

Prolapsed hemorrhoids can cause a variety of symptoms, including:

  • Pain and discomfort;
  • Bleeding;
  • Itching and irritation;
  • Feeling of fullness;
  • Visible hemorrhoids: Prolapsed hemorrhoids can be visible outside the anus as swollen and inflamed lumps.

 

Diagnostics

 

Diagnosing prolapsed hemorrhoids usually involves a physical exam and anoscopy. The doctor may perform a digital rectal examination to assess the severity of the condition and the presence of prolapse.

 

Treatment

 

Treatment for prolapsed hemorrhoids depends on the extent of the prolapse and the severity of the symptoms. Treatment can range from conservative methods to surgical intervention.

 

Conservative treatment

Conservative treatment includes:

  • Using creams and suppositories to relieve symptoms;
  • Change in diet to increase fiber and fluids;
  • Avoiding straining during bowel movements;
  • Warm sitz baths for pain relief.

 

Medical procedures

In more severe cases, medical interventions such as:

  • Ligation with rubber bands;
  • Sclerotherapy;
  • Infrared coagulation;
  • Surgery.

 

4. Thrombosis hemorrhoids

 

Thrombotic hemorrhoids are external hemorrhoids in which a blood clot has formed. This condition is extremely painful and often requires emergency medical intervention. Thrombosed hemorrhoids differ from other types of hemorrhoids in their severity and symptoms.

 

Causes of thrombosis

 

Thrombosis of hemorrhoids is due to impaired blood circulation in the hemorrhoidal veins. Reasons can include:

  • Prolonged straining during bowel movements;
  • Prolonged sitting or standing;
  • Intense physical activity;
  • Trauma to the hemorrhoids;
  • Pregnancy and birth;
  • Blood coagulation disorders.

 

Symptoms

 

Symptoms of thrombosed hemorrhoids are distinct and may include:

  • Intense pain;
  • Swelling;
  • Blue-violet color: Hemorrhoids often appear blue-violet due to the presence of a blood clot;
  • Hard lump: An affected hemorrhoid feels like a hard lump around the anus;
  • Bleeding: Mild bleeding may occur when the skin is broken over the thrombosed hemorrhoid.

 

Diagnostics

 

Diagnosis of thrombosed hemorrhoids usually involves physical examination and anoscopy. The doctor can assess the severity of the condition by visual examination and palpation of the affected area.

 

Treatment

 

Treatment for thrombosed hemorrhoids can vary depending on the severity of symptoms and the size of the thrombosed hemorrhoid.

 

Conservative treatment

In some cases, especially if the symptoms are not very severe, conservative treatment may be used, which includes:

  •  Analgesics: Taking analgesics to relieve pain;
  • Cold compresses: Application of cold compresses to reduce swelling;
  • Warm sitz baths: To relieve pain and reduce inflammation;
  • Using creams and ointments containing hydrocortisone or other anti-inflammatory agents.

 

Medical procedures

In more severe cases, medical intervention may be necessary:

  • Thrombectomy: This is a minor surgical procedure to remove the blood clot. It is performed under local anesthesia and leads to rapid pain relief;
  • Hemorrhoidectomy.

 

Medical procedures

 

5. Mixed hemorrhoids

 

Mixed hemorrhoids is a condition where both internal and external hemorrhoids are present at the same time. This is a complicated form of hemorrhoidal disease and requires specialized care and treatment. Mixed hemorrhoids can lead to significant discomfort and serious complications if not treated properly.

 

Causes of occurrence

 

The causes of the development of mixed hemorrhoids are similar to those of internal and external hemorrhoids, but their combination leads to more severe symptoms and complications. Key factors include:

  • Chronic constipation and straining during bowel movements;
  • Prolonged diarrhea;
  • Prolonged sitting or standing;
  • Pregnancy and birth;
  • Obesity;
  • Genetic predisposition;
  • Rectal muscle weakness.

 

Symptoms

 

Symptoms of mixed hemorrhoids are a combination of those of internal and external hemorrhoids and may include:

  • Bleeding;
  • Pain and discomfort;
  • Itching and irritation;
  • Swelling and inflammation;
  • Feeling of fullness;
  • Prolapse.

 

Diagnostics

 

Diagnosing mixed hemorrhoids usually requires a detailed medical examination, which may include:

  • Physical examination;
  • Anoscopy;
  • Sigmoidoscopy.

 

Treatment

 

Treatment of mixed hemorrhoids can be complex and require a combination of different methods depending on the severity of the condition.

 

Conservative treatment

Conservative treatment may include:

  • Pain relievers;
  • Warm sitz baths;
  • Creams and suppositories;
  • Changes in diet.

 

Medical procedures

In more serious cases, medical interventions such as:

  • Ligation with rubber bands;
  • Sclerotherapy;
  • Infrared coagulation;
  • Hemorrhoidectomy.

 

Prevention and prophylaxis

 

Preventing hemorrhoids is an important aspect of maintaining good health and avoiding the pain and discomfort associated with this condition. Prevention includes adopting a healthy lifestyle and certain habits that reduce the risk of developing hemorrhoids.

 

1. A healthy diet

Maintaining a diet rich in fiber is an essential element in the prevention of hemorrhoids. Fiber softens the stool and makes it easier to pass through the intestines, which reduces straining during bowel movements. Foods rich in fiber include:

  • Fruits: Apples, pears, strawberries, raspberries;
  • Vegetables: Broccoli, brussels sprouts, carrots;
  • Whole grains: Oatmeal, brown rice, whole grain bread;
  • Legumes: Beans, lentils, peas.

 

2. Drinking enough water

Hydration is a key factor in preventing constipation. Drinking enough water (usually 8 glasses a day) helps soften stools and make them easier to pass.

 

3. Regular physical activity

Physical activity improves circulation and supports gut health. Regular exercise, such as walking, running or swimming, can help prevent constipation and reduce pressure on the veins in the rectal area.

 

4. Correct habits when going to the toilet

Avoiding straining during bowel movements is important to reduce the risk of hemorrhoids. It is recommended to:

  • Go to the toilet as soon as you feel the need;
  • Avoid sitting on the toilet for a long time;
  • Use a footrest to help maintain proper posture.

 

5. Avoiding prolonged sitting or standing

Prolonged sitting or standing can increase the pressure on the veins in the rectal area. Taking frequent breaks and changing positions can help reduce this risk. If your  job requires prolonged sitting, it is helpful to take short walks or do stretching exercises every hour.

 

6. Maintaining a healthy weight

Obesity is a risk factor for the development of hemorrhoids. Maintaining a healthy weight through a balanced diet and regular exercise can reduce pressure on the veins in the rectal area and prevent hemorrhoids.

 

7. Correct hygiene of anus area

Good anus hygiene is important to prevent irritation and infection. Using wet wipes instead of toilet paper and cleaning the anus carefully after a bowel movement can help reduce the risk of developing hemorrhoids.

 

Hemorrhoids are a common problem that can cause significant discomfort, but with proper care and treatment they can be effectively managed. Understanding the different types of hemorrhoids, their symptoms, and treatment methods is key to managing them. Adoption of healthy habits and timely medical intervention can prevent complications and improve quality of life.

 

SOURCES:

1. Mayo Clinic: Hemorrhoids (26.05.2024).
2. WebMD: Hemorrhoid treatment for internal, external, or bleeding hemorrhoids (26.05.2024).
3. Healthline: Stang, D. Hemorrhoid surgery: Types, aftercare, and more (2023) (26.05.2024).