Hemroids are enlarged inflamed veins of the anorectal area. These veins are grouped into 2 sets of veins, internal hemorrhoidal veins and external hemorrhoidal veins. Therefore, there are 2 types of hemroids according to which set of veins are affected; we have internal hemroids and external hemroids.
In the following lines, we are going to discuss causes, symptoms and treatment of internal hemroids, also, we are going to discuss special features which distinguish internal hemroids from the other more common type; external hemroids.
Internal hemroids are caused by increased pressure inside the internal hemorrhoidal veins which weakens the muscle layer in their walls leading to their distension and dilatation and formation of a sac-like veins which may protrude from the anus.
The main symptom of internal hemroids is rectal bleeding with bowel movements. Bleeding is usually mild and very rarely severe to the degree that it causes anemia or iron deficiency. Blood is usually bright-red in color, dark blood or blood mixed with stools should increase the likelihood of a more proximal cause of bleeding. Rectal pain is usually absent or mild if any. If pain is severe in a case of internal hemroids, one should suspect thrombosis or infection of the hemorrhoidal veins. Sometimes, the hemorrhoidal veins enlarge enough to protrude from the anus forming a mass that can be palpated outside the anus. This is called a prolapsed internal hemroids which may be confused for external hemroids.
In general, internal hemroids are more difficult to diagnose than external hemroids, as the only complaint will usually be painless rectal bleeding with bowel movements. In addition, internal hemroids usually cannot be felt unless thrombosed.
Severity of internal hemroids. Internal hemroids are variable in severity, from grade I to grade IV. Grade I is usually asymptomatic but sometimes gives rise to minimal bleeding. Grades II to IV usually present with painless bleeding but sometimes dull aching pain is present due to prolapse.
Treatment of internal hemroids.
Non-operative procedures. In addition to general conservative measures used for hemroids treatment, there are non-operative procedures used specifically to treat internal hemroids. These procedures include:
Rubber band ligation. A rubber band is used to ligate the base of the swollen internal hemorrhoidal veins which become ischemic and then fall off. Repeating treatments may be required.
Infrared photocoagulation. Infrared light is used to coagulate the swollen internal hemorrhoidal veins causing their ischemia and sloughing.
