From the Guidelines
Signs and Symptoms of Internal Hemorrhoids
Internal hemorrhoids typically present with painless, bright red rectal bleeding, which may be accompanied by mucoid discharge and a sensation of incomplete evacuation 1. Symptoms may also include intermittent prolapse, which can be reduced manually, and may be associated with straining during defecation.
- The blood is typically bright red due to the arterial oxygen tension caused by arteriovenous communications within the anal cushions 1.
- Prolapse of the rectal mucosa leads to deposition of mucus on the perianal skin, causing itchiness and discomfort 1.
- Prolapsed hemorrhoids are a cause of soiling and mucus discharge, and both lead to secondary pruritus ani 1.
- Advanced prolapsed hemorrhoids may become incarcerated and strangulated 1. Some patients may experience anal itching, but this is just as likely to be due to inadequate hygiene, minor incontinence, or perianal dermatitis 1. It is essential to note that bleeding is the most common presenting symptom of hemorrhoids, and a precise patient history and a careful physical examination are essential for accurate diagnosis 1.
From the Research
Signs and Symptoms of Internal Hemorrhoids
- Internal hemorrhoids typically present with prolapse or painless rectal bleeding 2, 3
- Bright red, painless rectal bleeding during defecation is the most common presentation of internal hemorrhoids 3
- Hemorrhoidal size, thrombosis, and location determine the extent of pain or discomfort 4
- Internal hemorrhoids are traditionally graded from I to IV based on the extent of prolapse, with other factors such as degree of discomfort, bleeding, comorbidities, and patient preference also considered 4
Key Characteristics
- Internal hemorrhoids are engorged fibrovascular cushions lining the anal canal 3
- Constipation, increased intra-abdominal pressure, and prolonged straining predispose to hemorrhoids 3
- Approximately 1 in 20 Americans and almost one-half of individuals older than 50 years experience symptomatic hemorrhoids 3
Diagnosis and Considerations
- Even if hemorrhoids are seen on examination, patients with rectal bleeding who are at risk of colorectal cancer should still undergo colonoscopy to exclude cancer as the etiology 3
- The history and physical examination must assess for risk factors and clinical signs indicating more concerning disease processes 4