Hemorrhoids are cushions of tissue, located in the lower rectum, that contain blood vessels, muscle and elastic fibers. Hemorrhoids contribute to our resting continence, meaning they assist the body in controlling the expulsion of stools. When you’re not experiencing itching, burning or discomfort from hemorrhoids, you probably don’t think about them at all, but they’re always there.
As with other tissue in your body, hemorrhoids can swell or become inflamed. This tends to occur when the connective tissues in a hemorrhoid weaken, allowing the hemorrhoid to slip down into the anal canal.
When hemorrhoids become swollen or inflamed, they may be referred to as piles, though are often still called “hemorrhoids”.
We will refer to inflamed hemorrhoids as both piles and hemorrhoids according to the common usage.
Experiencing inflamed hemorrhoids is a common issue that affects about half of adults by the time they reach 50. While many people get hemorrhoids in older adulthood, anyone can experience this problem.
Medical professionals classify hemorrhoids mainly according to whether they are internal or external. As you’ll see, there are further classifications within these two categories.
Internal hemorrhoids exist inside the rectum, out of sight. Because there are no nerve endings in the rectum, these hemorrhoids are typically painless. The most common symptom of internal hemorrhoids is bleeding. You may see small amounts of bright red blood on your toilet paper or inside the toilet bowl. Internal hemorrhoids can also cause itching. Hemorrhoids that bleed but remain concealed in the rectum are classified as Grade I hemorrhoids.
While internal hemorrhoids typically go unseen, they can also push through the anal opening. These are known as prolapsing or prolapsed hemorrhoids. When prolapse occurs, internal hemorrhoids can be classified using a grading scale:
Prolapsed hemorrhoids can lead to the development of excess skin, called skin tags. In most cases, treating internal hemorrhoids will relieve the external symptoms. You may also want to have the skin tag removed, but this is not necessary for recovery.
External hemorrhoids often occur as bulges or lumps around the anus. Unlike internal hemorrhoids, you can feel these from the outside. Some people may mistake a prolapsed internal hemorrhoid for an external hemorrhoid. The difference is that external hemorrhoids form on or around the anus rather than descending down the rectum. Another way to tell the difference is that external hemorrhoids do not bleed, therefore if you are experiencing bleeding as a symptom and have ruled out anything more serious – you likely have internal hemorrhoids
People can also mistake external skin tags or irritation caused by internal hemorrhoids for an external hemorrhoid. In fact, most patients who complain about external issues are also suffering from internal hemorrhoids. This means addressing the internal hemorrhoids can provide external relief.
Because of the sensitive nerve fibers in this area, external hemorrhoids are often painful, especially when sitting. They also may bleed and itch. Pain can become even more severe if a blood clot forms in the hemorrhoid. Hemorrhoids containing blood clots are called thrombosed hemorrhoids. These can be internal, but they are more often external. These hemorrhoids are not especially dangerous, but they can be particularly uncomfortable.