Leukemia (Blood Cancer)

 This lesson is about the signs and symptoms of hemorrhoids! In this lesson, we're going to talk about why these signs and symptoms occur we're also going to talk about the differences between internal and external hemorrhoids with regards to signs and symptoms but first we should know what hemorrhoids are.

Hemorrhoids are vascular cushions or tissues that aid in fecal continence so here is a diagram of both internal and external hemorrhoids, now everyone has these vascular cushions or tissues but the problem arises when these vascular cushions or tissues become problematic if they become enlarged or irritated people can experience what we call hemorrhoidal disease, so hemorrhoids are present in the anal canal and they're supported by a muscle known as the trites muscle.

Now as I mentioned before they only cause a problem when there are signs and symptoms if they become irritated if they become enlarged and it's estimated that approximately three-quarters of adults will suffer from the hemorrhoidal disease at some point in their lives now how do we distinguish between internal and external hemorrhoids so in this diagram I showed you before there is something denoted the dentate line and this is how internal and external hemorrhoids are defined by the location relative to this dentate line if the hemorrhoids are proximal above the dentate line they are known as internal hemorrhoids and if the hemorrhoids are distal to the dentate line or below the dentate line they are known as external hemorrhoids and from now on when I refer to internal and external hemorrhoids, I'm referring to the signs and symptoms associated with a hemorrhoidal disease or issues of the internal-external hemorrhoids and before I get into the sign symptoms of hemorrhoids. It's important to note that 40% of patients with the hemorrhoidal disease are asymptomatic which means that they don't experience any symptoms so they could have had issues with their hemorrhoids in the past but presently they don't have any symptoms so 40% of patients will have no symptoms at all.

Let's first talk about the signs and symptoms of internal hemorrhoids so the first and the most important sign or symptom we're going to see with internal hemorrhoids is bright red blood per rectum, this is actually the most common symptom and we see it at the end of a bowel movement so after a bowel movement, we can often see bright red blood in the toilet and on toilet paper. Another important symptom of internal hemorrhoids is a sensation of what we call rectal fullness and this is more of a sensation of prolapse of tissue so if an internal hemorrhoid becomes so enlarged and it moves or changes location a patient can sense this they can feel a sensation of rectal fullness and again this is due to the prolapse of internal hemorrhoid or multiple internal hemorrhoids and patients often describe feeling like they're sitting on something.

Other signs and symptoms of internal hemorrhoids include mucus discharge, so this is also due to prolapse of internal hemorrhoids so again if that internal hemorrhoid becomes so enlarged and it changes position so it prolepses it can interfere with a patient's ability to have normal fecal continence so they can have some mucous discharge the mucus may be present at the end of a bowel movement like bright red blood and it can be found in the toilet or toilet paper and I alluded to this before but another symptom of internal hemorrhoids is incontinence and again this is due to prolapse of internal hemorrhoid this interferes with the patient's ability to have normal fecal continence.

Oftentimes the incontinence is very mild although it can be more problematic for some patients and it causes irritation and difficulty with hygiene. It can cause significant decreases in quality of life. Hence, even though it's maybe mild it can lead to issues with the quality of life some other signs and symptoms of internal hemorrhoids include pruritus! So pruritus is a sensation of itching this is again due to prolapse of internal hemorrhoid or irritation and or incontinence so if there's irritation of hemorrhoid if the hemorrhoid is irritated or if there's some incontinence or mucus discharge it can lead to irritation of surrounding tissue causing some sensation of itching and we can also see issues with pain but what I want you to take away from this is that most often internal hemorrhoids are painless so no pain at all and what is classically described with internal hemorrhoids is bright red blood per rectum.

That is painless so bright red blood rectum that is painless if an individual does experience pain it's more often caused by a thrombosed internal hemorrhoid which means that there's a clot formed in that internal hemorrhoid that can cause pain to occur and some other sensations that a patient may have with internal hemorrhoids includes burning and other discomfort but again what I want you to take away is that most often internal hemorrhoids are painless and we often see bright red blood per rectum.

Now let's talk about external hemorrhoids so one of the first things we're going to note with regards to external hemorrhoids is a peri-anal mass or swelling so here is a prolapsing internal hemorrhoid as I have mentioned before and here is external hemorrhoid because the external hemorrhoid is below the dentate line we're more likely to see it so we're more likely to see a perianal mass or swelling so as I mentioned before it's oftentimes a visible mass and it looks like a firm nodule that is purple in coloration and what can be noted is that this purple firm nodule can increase in size over time so as the external hemorrhoid increases in size it becomes more problematic that visible mass can appear larger and larger over time.

Another important symptom of external hemorrhoids is pain this pain with regards to external hemorrhoids is more likely to be sudden and severe and it's more likely to occur when the external hemorrhoid has become thrombosed so when a clot forms in that external hemorrhoid and when there is a clot that has formed that peri-anal mass that peri- anal swelling or visible mass that we talked about before is oftentimes tender to touch so it might not have been tender to touch before he might have been able to see it but later on if there's a clot that forms in that hemorrhoid it becomes tender to touch later and the reason why external hemorrhoids are more likely to cause pain or their pain is more likely to be severe compared to internal hemorrhoids is because irritation of those external hemorrhoids can lead to activation of peri-anal innervations so those peri- anal innervations are more closely located near the external hemorrhoids so they're more likely to become activated and cause pain.

Another sign of external hemorrhoids is bleeding this is often from an ulcerated external hemorrhoid so that hemorrhoid that is on the outside that visible mass can become ulcerated and it can lead to some bleeding and again an ulcerated external hemorrhoid is more likely to occur if an external hemorrhoid has become thrombosed and the difference here between bleeding in external hemorrhoids and bleeding in internal hemorrhoids is that the bleeding in external hemorrhoids is darker in coloration so darker blood and oftentimes you can see clots bleeding in external hemorrhoids are more likely to be from an ulcerated external hemorrhoid and it's more likely to be darker in coloration with visible clots.

Another symptom of external hemorrhoids is Pruritus so again that sensation of itching and this is due to surrounding irritation from the external hemorrhoid itself, another sign we can see with external hemorrhoids that we don't see with internal hemorrhoids are external skin tags so these external skin tags are painless and they are often a sign of previous hemorrhoidal disease and edema so if there had been some issue with a hemorrhoidal disease in the past and there's some swelling in that area that has now resolved it can lead to external skin tags but even though I mentioned that they are oftentimes a sign of previous hemorrhoidal disease they may also be a sign of Fischer disease or anal fissures. (So if you want more information on Fischer disease, stay tuned to my website, soon the topic will be published). So again external skin tags are a sign of previous external hemorrhoidal disease and they're painless but they can also be a sign of Fischer disease.

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