A thorough evaluation and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer, bleeding ulcers, inflammatory bowel diseases (such as Crohn's disease and ulcerative colitis), and anal tears.
A doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.
Closer evaluation of the rectum for hemorrhoids requires an exam with an anoscope. An anoscope is a hollow, lighted tube useful for viewing internal hemorrhoids. A proctoscope is more useful for completely examining the entire rectum.
To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and lower colon, or sigmoid, with sigmoidoscopy or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures that also involve the use of lighted, flexible tubes inserted through the rectum.
signs and symptoms
Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching, also called pruritus ani, have similar symptoms and are incorrectly referred to as hemorrhoids. Anal fissures are cuts or tears occuring in the anus. An anal fistula is a small tunnel with an internal opening in the anal canal and an external opening in the skin near the anus. It forms when an anal abscess that's drained (either on its own or via surgery) does not heal completely. An anal abscess is a collection of pus in the deep tissues surrounding the anus.
Hemorrhoids usually are not dangerous or life threatening. In most cases, hemorrhoidal symptoms will go away within a few days.
Hemorrhoid symptoms usually depend on the location.
Internal hemorrhoids: Internal hemorrhoids cannot be seen or felt. Straining or irritation from passing stool can injure a hemorrhoid's delicate surface and cause it to bleed. Individuals may notice small amounts of bright red blood on toilet tissue or in the toilet bowl water. Because internal anal membranes lack pain-sensitive nerve fibers, these hemorrhoids usually do not cause discomfort. Occasionally, straining can push an internal hemorrhoid through the anal opening. If a hemorrhoid remains displaced (called prolapsed), it can cause pain and irritation. Internal hemorrhoids may not be noticed since they do not cause pain and discomfort.
External hemorrhoids: External hemorrhoids tend to be painful. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), causing severe pain, swelling, and inflammation. External hemorrhoids can itch or bleed when irritated.
When internal and external hemorrhoids occur at the same time, they are referred to as mixed hemorrhoids.
Hemorrhoids can produce several uncomfortable, but non-serious problems. A blood clot in the hemorrhoid may cause severe pain and usually demands immediate medical attention. Hemorrhoids can ooze fresh red blood, whether located externally or internally. External hemorrhoids often cause dripping of blood from the anus while sitting on the toilet. The blood might also be seen as a stain on the underwear. Internal hemorrhoids that bleed may produce fresh blood in the stool. External hemorrhoids can be itchy, especially if the area is moist and irritated.
Hemorrhoids do not develop into cancer. However, both hemorrhoids and cancer can cause rectal bleeding. In fact, many disorders can be the cause of rectal bleeding. When rectal bleeding occurs in persons over age 30, and especially in those over age 50, it should be considered a serious problem until an exact diagnosis is made.
causes and risk factors
Hemorrhoids can develop from any increase in pressure in the veins in the lower rectum. Common sources of pressure and hemorrhoid causes include: constipation and straining; diarrhea; sitting (especially on the toilet) or standing for a long time (such as at a job); obesity; diet, especially high in red meats and low in fiber; pregnancy and childbirth. Hereditary factors may also be involved in the risk of developing hemorrhoids, such as in those predisposed to having weakened blood vessels.