What Are the Different Types of hemorrhoids?

types of hemorrhoids

Story at-a-glance -

  • There are four types of hemorrhoids, and you can tell them apart by their location, symptoms and possible side effects that are itchy, painful or both
  • Learn the different types of hemorrhoids and their symptoms so you can properly treat them

It’s important to know that not all hemorrhoids are the same. There are actually four types of hemorrhoids, and you can tell them apart by their location, symptoms and possible side effects that are itchy, painful or both.

Internal Hemorrhoids

Internal hemorrhoids are found inside the rectum and develop above the pectinate line, a boundary that divides the upper two-thirds of the anal canal from the lower third.1,2 A lining called mucosa, which isn’t sensitive to touch, pain, stretching or temperature, surrounds the internal hemorrhoids.3 Internal hemorrhoids can be classified into four stages, depending on the level of the protrusion:4

  • Grade I While these hemorrhoids are prominent and may bleed, they don’t protrude into the anal canal.
  • Grade II Bowel movements can cause the hemorrhoids to prolapse outside of the canal, but they spontaneously move back inside afterward.
  • Grade III Hemorrhoids may protrude past the anal opening even if no straining occurs, and they have to be pushed back inside manually.
  • Grade IV Hemorrhoids have prolapsed and are found outside the anal canal. They do not remain inside the rectum and cannot be pushed back in.5 If these aren’t addressed, there’s a risk for thrombosis or strangulation.

If you notice bleeding during a bowel movement, whether on your stool, toilet paper or in the toilet bowl, this is a sign that you may have internal hemorrhoids.6,7 Bleeding happens when you pass stool, since it scrapes off the thinned lining of the hemorrhoid.

Although inflamed internal hemorrhoids may swell, MedicineNet notes that you won’t feel that much aching because there aren’t any pain fibers connected to veins above your pectinate line. However, there’s a possibility for muscle spasms to develop around your rectum and anus because of this swollen hemorrhoid.

These spasms tend to be painful if the hemorrhoids protrude or prolapse through the anus, and you may feel a lump at the anal verge. The spasms can also lead to the formation of a painful thrombose or clot. Mucus from the hemorrhoid may also leak, and this can inflame the skin around the anus and cause pruritus ani or anal itching.8

Prolapsed Hemorrhoids

These refer to hemorrhoids that have protruded through the anal canal.9 Prolapsed hemorrhoids often cause blood to appear on your stool, in the toilet bowl or on toilet paper. In some cases, people with prolapsed hemorrhoids also feel anal itching or incomplete evacuation, a feeling of discomfort that occurs when a person feels they may not have passed stool completely.10,11

Patients with prolapsed hemorrhoids may feel immense pain because of the pain-sensing nerves within them, as well as other causes such as:12,13

  • Thrombosis, or formation of blood clots that may eventually block blood vessels14
  • Strangulated hemorrhoids, wherein the hemorrhoids’ blood supply has been entirely cut off15

External Hemorrhoids

According to Mayo Clinic, external hemorrhoids develop under the skin located around your anus.16 These hemorrhoids can feel lumpy and have a bluish color,17 and trigger symptoms such as:18

  • Itching and painful sensation in the anal area
  • Slight pink tinge compared to surrounding skin
  • Presence of blood during bowel movements
  • Presence of blood clots

External hemorrhoids have pain fibers attached to them, and are covered with “regular skin”19 that may cause perianal skin tags to appear.20 These tags appear because hemorrhoids may stretch the skin above the swelling, leaving a tag even if the hemorrhoid has already been healed.21 Skin tags may cause difficulties with cleaning after a bowel movement, as well as trigger secondary skin infections.22

Thrombosed External Hemorrhoids

Often seen as a hard and painful lump in the anus, thrombosed external hemorrhoids occur when an underlying vein in the hemorrhoid forms a clot in one or more of the small veins.23 This results in pain,24 swelling and inflammation,25 especially if there is rapid stretching of the skin covering the hemorrhoid.26 Thrombosed external hemorrhoids are common among pregnant women and young adults.27

MORE ABOUT HEMORRHOIDS

Hemorrhoids: Introduction

What Are Hemorrhoids?

Hemorrhoids Causes

Hemorrhoids Types

Hemorrhoids Symptoms

Hemorrhoids In Pregnancy

Hemorrhoids Treatment

Hemorrhoids Surgery

Hemorrhoids Prevention

Essential Oils for Hemorrhoids

Hemorrhoids Diet

Hemorrhoids FAQ

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