Internal Haemorrhoids are clumps of tissue within the anal canal that contain blood vessels, muscle, and elastic fibers. External Haemorrhoids are enlarged blood vessels surrounding the anus. Internal Haemorrhoids cause problems when they enlarge. The cause of the enlargement is not known.
As the anal cushion of an internal Haemorrhoid enlarges, it bulges into the anal canal, loses its normal anchoring, and protrudes from the anus as a prolapsing internal Haemorrhoid. The Haemorrhoid is exposed to the trauma of passing hard stools, causing bleeding and sometimes pain.
The rectal lining that has been pulled down can secrete mucus. The presence of stools and constant moisture can lead to anal itchiness (pruritus ani), though itchiness is not a common symptom of Haemorrhoids.
The following are the different types of Haemorrhoids:
By the history of symptoms, we can suspect that Haemorrhoids are present. The diagnosis of an internal Haemorrhoid is easy if the Haemorrhoid protrudes from the anus. Although a rectal examination with a gloved finger may uncover an internal Haemorrhoid high in the anal canal, a more thorough examination for internal Haemorrhoids is done visually using an proctoscope. As the proctoscope is withdrawn, the area of the internal Haemorrhoids is well seen. Straining by the patient may make the Haemorrhoids more prominent.
It is believed generally that constipation and straining to have bowel movements promote Haemorrhoids and that hard stools can traumatise existing Haemorrhoids. It is recommended, therefore, that individuals with Haemorrhoids soften their stools by increasing their fluid and fiber intake in their diets. This is recommended for all patients who have Haemorrhoidal symptoms and can be the only treatment required for patients with first degree Haemorrhoids.
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