Hemroids (or hemorrhoids) are swollen, inflamed anorectal veins due to increased pressure inside them as a result of a variety of causes, the most important of which are straining e.g. from constipation, pregnancy causing mechanical compression of the pelvic veins, in addition to hormonal changes causing weakness of the walls of anorectal veins, obesity and old age.

Hemroids are of 2 types; internal hemroids, in which, the internal hemorrhoidal veins are swollen, and external hemroids, in which, the external hemorrhoidal veins are swollen.

Common symptoms of hemroids include rectal pain, discomfort, itching and irritation with passage of stools. Another  important symptom is rectal bleeding which occurs with bowel movements. Such condition is known as bleeding hemroids.

Bleeding hemroids are a special case of internal hemroids. You should note that rectal pain without bleeding is the main symptom of external hemroids, while rectal bleeding without pain is the main symptom of internal hemroids.

While rectal bleeding may occur from other causes than hemroids, bleeding hemroids is the most common cause of rectal bleeding. Other causes of rectal bleeding include anal fissure, however bleeding hemroids is characterizes by bleeding which occurs at the time of bowel movements but not at other times.

Bleeding in hemroids is caused by scratching of the swollen veins by hard stools or by rubbing the anal area. Bleeding is usually mild and stops rapidly and is rarely severe enough to cause anemia.

Thrombosed bleeding hemroids are a special type of bleeding hemroids and are caused by thrombosis (or clotting) of blood in the swollen hemorrhoidal veins. It is one of the causes of pain in internal hemroids, remember that pain is usually absent or minimal in cases of internal hemroids.

In bleeding hemroids, the most important finding to observe is the color of the blood, as it distinguishes bleeding hemroids from other probably more serious causes of rectal bleeding, how? The blood of hemroids is almost always bright-red in color, if the color is dark-red or black, the case should be investigated thoroughly to exclude other possible medical causes.

In case of any doubt, or if the more serious causes of rectal bleeding can’t be excluded on clinical grounds, investigations may be required to confirm the diagnosis. The most important investigations are proctoscopy and colonoscopy to directly visualize the anorectal area and also allows for biopsy taking for pathological examination.