Hemorrhoids are a common condition often discussed in daily life, particularly prevalent among men. This embarrassing ailment can cause acute pain during important occasions, leaving sufferers restless and uncomfortable. Today, we outline the symptoms of hemorrhoids.
What are the symptoms of hemorrhoids?
Primary Symptoms
(1) Rectal bleeding
Characterized by painless, intermittent bright red blood after bowel movements, this is a common early symptom of internal or mixed hemorrhoids. Bleeding typically occurs when stool tears the mucous membrane or excessive straining during defecation ruptures dilated blood vessels.Mild cases may show blood streaks on stool or toilet paper, progressing to dripping blood. Severe cases present with projectile bleeding, which often stops spontaneously after several days. This pattern is crucial for diagnosis. Constipation, hard stools, alcohol consumption, and spicy foods can trigger bleeding. Prolonged recurrent bleeding may cause anemia—a common clinical finding requiring differentiation from bleeding disorders.(2) Prolapse of Hemorrhoidal Masses This is typically a late-stage symptom, often preceding prolapse after initial bleeding. As hemorrhoids enlarge in advanced stages, they gradually separate from the muscle layer and are pushed out of the anus during defecation.Mild cases prolapse only during defecation and retract spontaneously afterward. Severe cases require manual repositioning. In the most severe form, even slight abdominal pressure—such as coughing or walking—causes prolapse that is difficult to reduce, rendering the patient unable to work. A minority of patients report prolapse as the initial symptom.
(3) Pain
Simple internal hemorrhoids are typically painless, though some may experience a sensation of heaviness. Pain of varying intensity occurs when internal or mixed hemorrhoids prolapse and become incarcerated, leading to edema, infection, or necrosis.
(IV) Itching
Advanced internal hemorrhoids, prolapsed hemorrhoidal tissue, and anal sphincter relaxation often lead to mucus discharge. This secretion irritates the perianal area, causing persistent itching and discomfort. In severe cases, perianal dermatitis may develop, causing significant distress to the patient.
Classification
1. Internal Hemorrhoids
Based on location, internal hemorrhoids are classified as primary (primary hemorrhoids) or secondary (secondary hemorrhoids).This relates to vascular branching patterns. The terminal branches of the superior rectal artery primarily supply the right anterior, right posterior, and left mid-rectal columns. The superior rectal veins running parallel to these three areas are relatively tortuous, forming the internal hemorrhoidal venous plexuses. Dilated, tortuous, and congested venous plexuses in the right anterior, right posterior, and left mid-rectal columns constitute primary internal hemorrhoids.Secondary internal hemorrhoids may number 1 to 4, often connected to the primary hemorrhoids in the right posterior and left midline regions (as veins in these areas branch further). Veins in the right anterior primary hemorrhoid area typically do not branch again, thus often occurring singly without secondary hemorrhoids. However, the positions of primary and secondary hemorrhoids also vary:Some may be isolated, while others may be clustered together. When both the primary and secondary hemorrhoids prolapse outside the anus in a plum blossom pattern, it is termed annular hemorrhoids. If the prolapsed internal hemorrhoids become edematous and cannot be reduced, it is called prolapsed internal hemorrhoids. If there is impaired blood circulation, it is termed strangulated internal hemorrhoids.
(1) Symptoms and Signs
① Rectal bleeding: Characterized by painless, intermittent bright red blood after defecation, this is a common early symptom of internal or mixed hemorrhoids. Bleeding typically occurs when stool abrasions or straining rupture dilated vessels. Mild cases present as blood streaks on stool or toilet paper, progressing to dripping blood,to projecting blood in severe cases. Bleeding often resolves spontaneously after several days, which is diagnostically significant. Constipation, hard stools, alcohol consumption, and spicy foods are common triggers. Prolonged recurrent bleeding may lead to anemia, a clinically common finding that requires differentiation from bleeding disorders.② Prolapse of hemorrhoidal tissue: Typically a late-stage symptom, often preceded by bleeding before prolapse occurs. As hemorrhoids enlarge in advanced stages, they gradually separate from the muscle layer and are pushed out of the anus during defecation. Mild cases prolapse only during bowel movements and retract spontaneously afterward.while more severe cases require manual repositioning. In the most severe form, even slight abdominal pressure causes prolapse, such as during coughing or walking. Prolapse becomes difficult to reduce, preventing normal activities. A small number of patients report prolapse as the initial presenting symptom.
③ Pain: Simple internal hemorrhoids are typically painless, though some may experience a sensation of heaviness. Pain of varying intensity occurs when internal or mixed hemorrhoids prolapse and become incarcerated, leading to edema, infection, or necrosis.④ Itching: In advanced internal hemorrhoids, prolapsed hemorrhoidal masses and anal sphincter relaxation often lead to discharge. This secretion irritates the perianal area, causing itching discomfort and sometimes eczema, which is extremely unpleasant for patients.