The main symptom of internal hemorrhoids is hematochezia, and larger internal hemorrhoids are accompanied by prolapse. Due to the different duration of the disease, it can be divided into the following stages.
Early stage: Hemorrhoids are small, soft and bright red, and often bleed due to stool rubbing against hemorrhoids. The blood that flows out is either like an arrow or dripping, which is painless and not drooping, so it has the characteristics of blood.
Mid-stage: the hemorrhoid nucleus is large and soft, and the hemorrhoid surface is bright red or blue-purple. When defecating, the hemorrhoid nucleus protrudes from the anus, and then it automatically recovers after defecation, and bleeding is more or less after defecation.
Late stage: the hemorrhoid nucleus is large, the texture is hard, and the surface is slightly gray (that is, fibrous internal hemorrhoids). When defecating, hemorrhoids will come out of the anus, even when walking, coughing, sneezing, or standing, they cannot recover on their own. You must push it back by hand, or lie flat and apply hot compress to recover, and there is not much stool or bleeding.
Complications: Anal dilatation and itching may occur in the middle and late stage. For example, acute thrombotic impaction of hemorrhoid nucleus can cause swelling and pain, erosion, necrosis, and even suppuration, followed by anal leakage. Long-term hematochezia can cause anemia.
External hemorrhoids occur below the anal canal tooth line and are caused by varicose veins or repeated inflammation of external hemorrhoids. Its surface is covered with skin, which is not easy to bleed and has irregular shape and size.
The main symptoms of external hemorrhoids are swelling pain and foreign body sensation. According to its development process, it can be divided into external hemorrhoids, venous dilated external hemorrhoids and thrombotic external hemorrhoids.
Extra external hemorrhoid of skin: the extra flap at the edge of anus gradually increases, with soft texture, generally no pain and no bleeding. Only when the anus has foreign body sensation, occasionally poisoning, swelling and congestion will cause pain. Once the swelling disappears, excess skin still exists.
Venous external hemorrhoids: most of them are recurrent prolapse of internal hemorrhoids in the middle and late stage, or the abdominal pressure increases during pregnancy, which hinders the reflux of superficial veins and subcutaneous lymph, causing the external venous plexus below the anal canal tooth line to expand and varicose veins. Its clinical manifestations: there are oval or long tumors in local areas, which are soft to the touch and usually not obvious. When defecation or squatting increases abdominal pressure, the tumor volume increases to dark purple, which is difficult to press. After defecation or massage, the tumor volume can be reduced and softened. Generally, there is only a feeling of bloating, and there is no pain. If the tumor does not shrink after defecation, it will cause pain when it causes edema of surrounding tissues. Patients with varicose external hemorrhoids are often accompanied by internal hemorrhoids.
Thrombotic external hemorrhoid: due to constipation, excessive force during defecation, or after strenuous exercise, the external hemorrhoid vein ruptures and the blood quickly coagulates to form a thrombus. Its clinical manifestations: sudden and severe pain in the anus, and a tumor, which is very sensitive, will cause pain at the slightest touch, so defecation, sitting, walking and even coughing will aggravate the pain.
Mixed hemorrhoid: it is varicose veins of internal hemorrhoid and external hemorrhoid, which communicate with each other and overlap, and the groove between sphincter disappears, so that internal hemorrhoid and external hemorrhoid form a whole. It has the same characteristics as internal hemorrhoids and external hemorrhoids.