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Hemorrhoids: Symptoms and diagnosis

Symptoms

Hemorrhoids generally do not cause any symptoms except when enlarged, inflamed, thrombosed or prolapsed. In some cases symptoms disappear within a few days.  But in most cases, hemorrhoid symptoms eventually return and are often worse than they were before.

Symptom of Internal Hemorrhoids

• A splash of bright red blood at defecation. The most common symptom of internal hemorrhoids is bright red blood covering the stool.

• Pain in the anus. Internal hemorrhoids do not cause pain,but they can bleed and prolapse. When they prolapse, internal hemorrhoids can cause pain.

• Mucous on underwear and itch. Internal hemorrhoids deposit mucous onto the skin around the anus when they prolapse. This mucous contains
some stool contents that can cause localized dermatitis and itching. Mucous may cause staining of the underwear.

Symptom of External Hemorrhoids

• Itching.

• Pain.
External hemorrhoids can get thrombosed due to physical exertion, severe straining, a bout of diarrhea or a change in diet.  This produces a painful swelling around the anus. The pain lasts for 7-14 days and decreases slowly.  With resolution of the thrombosis, the stretched skin persists as excess skin or skin tags.

• Bleeding.
External thromboses can occasionally erode the overlying skin and cause bleeding.

Diagnosis

Many anorectal problems, like fissures, fistulae, abscesses, or irritation and itching (pruritus ani), have symptoms similar to hemorrhoids. Therefore investigations are necessary to rule out these conditions.

• Anoscopy and proctoscopy. These are done to view internal hemorrhoids.
• Sigmoidoscopy and colonoscopy. These are done to rule out other causes of gastrointestinal bleeding.

• X-ray (Barium enema).

This is suggested if proximal colonic disease is suspected as a cause of bleeding. Colonoscopy and barium enema are reserved for cases of bleeding without an identified anal source.

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