Hemorrhoids Signs and Symptoms

External vs Internal Hemorrhoids

• If hemorrhoids are present, differentiate between external and internal hemorrhoids
• Hemorrhoids are classified according to their location relative to the dentate line

External Hemorrhoids

• Located closer to the anal verge and are covered with squamous epithelium
• Produce symptoms only when thrombosed or when they give rise to large skin tags which make hygiene difficult
• Common symptoms are anal pain of acute onset and a palpable lump in the perianal area

Internal Hemorrhoids

• Originate above the dentate line and are covered with rectal or transitional mucosa
• Do not cause cutaneous pain
• Prolapse of internal hemorrhoids may cause bleeding, mucus discharge, fecal soiling and anal pruritus

• Rectal bleeding
  
  • Most common presenting symptom
  • Bright red blood which may drip or squirt into the toilet bowl or scanty amounts may be seen on toilet tissue

• Discomfort due to rectal protrusion or lump
• Anal pain
• Anal itching