Types of Haemorrhoids

Haemorrhoids are a group of veins located in the last part of the digestive tract, more specifically in the anus and anal canal. We all have these haemorrhoidal veins, to a greater or lesser extent, as they form part of our continence mechanism together with the anal sphincter.

The medical problem appears when, due to a series of factors, such as diet, excess weight, constipation, diarrhoea, sedentary lifestyle, etc., these veins become irritated, increase in size or protrude outwards (in the case of internal haemorrhoids) causing symptoms such as itching, pain, itching and even bleeding.

Haemorrhoids are generally not painful, as long as they do not form clots, in which case they cause a lot of pain and serious discomfort.

Bear in mind that suffering from haemorrhoids is one of the most common problems in the field of general surgery and the digestive system, with data indicating that approximately 50% of the population will suffer from haemorrhoids at some time in their lives. 

However, this does not imply that the discomfort caused by haemorrhoids should require surgical treatment as, in many cases, it is possible to solve it with pharmacological treatment and by following a balanced diet.

First of all, you should know that haemorrhoids are classified into two types that are differentiated mainly by the location of the inflamed haemorrhoidal veins: external haemorrhoids and internal haemorrhoids. 

We explain the characteristics of both types below:

External haemorrhoids

External haemorrhoids are so called because the veins on the outside of the anus are covered by skin. In this type of haemorrhoids, bleeding is rare as the skin covering the veins prevents the blood from flowing out.

It should be borne in mind that haemorrhoids can thrombose when straining during defecation, which leads to the appearance of a lump in the anal region, which is significantly painful and purplish-blue in colour.

Another characteristic of external haemorrhoids is that, on occasions, haemorrhoids that are in an acute phase can develop a haemorrhoidal thrombosis. 

This consists of the formation of clots inside the haemorrhoid, which cause extremely intense pain and may require urgent surgery. In the case of acute haemorrhoidal thrombosis, it is possible that the pressure caused by the haematoma may cause an ulcer in the skin with the consequent exit of the clot and bleeding.

How should external haemorrhoids be treated?

In general, external haemorrhoids can be treated with pharmacological measures and home care, such as sitz baths with warm water, anti-inflammatory drugs and the application of ointments.

As for the surgical procedure, specialists only recommend it when the external haemorrhoid is very large and pharmacological treatments have no effect.

External haemorrhoids are located at the edge of the anus, while internal haemorrhoids are located in the anal canal.

Internal haemorrhoids

On the other hand, internal haemorrhoids, as the name suggests, are those that occur inside the anal canal and are invisible under normal conditions. These haemorrhoids are the most annoying, as they are covered by mucosa rather than skin and are much more vulnerable to friction and pressure caused by faeces during bowel movements.

In terms of symptoms, the most relevant is bleeding during bowel movements and even into underwear throughout the day. It is also characterised by a feeling of heaviness in the area.

In addition, one of the most feared aggravations in the case of internal haemorrhoids is when they slide outwards and are exposed to the friction of underwear, toilet paper, etc. In these cases, the haemorrhoids erode and there is significant bleeding.

How should internal haemorrhoids be treated?

As with external haemorrhoids, for internal haemorrhoids in their milder grades (grade 1 and 2) specialists recommend starting with pharmacological treatment and care (sitz baths).

On the other hand, if internal haemorrhoids are more serious, grade 3 or 4, the specialist will most likely opt for a haemorrhoid operation.

If you are suffering from the discomfort caused by haemorrhoids and are looking for a specialist in your city, you can click on the following image and request a free surgical assessment consultation with our General and Digestive System Surgery Specialists.

Internal haemorrhoids can be divided into four levels according to their severity. 

To determine the degree, specialists take into account factors such as the size of the haemorrhoid, the discomfort, the presence of bleeding and whether it has moved to the outside of the anal canal. 

Below we explain each grade of internal haemorrhoids one by one:

• Grade I: In this case, haemorrhoids cause bleeding during bowel movements, itching and a feeling of heaviness. The internal haemorrhoidal veins are dilated but do not protrude during defecation.
• Grade II: During bowel movements, the internal haemorrhoidal bundles protrude, but in this case they return to their original position on their own when they have finished. Other symptoms are itching and the sensation that the rectum is clogged.
• Grade III: Bleeding occurs and during bowel movements the haemorrhoids come out. In this case, the bundles of haemorrhoidal veins do not return to the inside spontaneously, but must be reintroduced by the patient himself using his own hand. Symptoms at this level of severity are itching, pain and sometimes staining of underwear.
• Grade IV: This is the most severe case of haemorrhoids and usually requires surgery in most cases. The haemorrhoids remain on the outside of the anus for most of the day, bleeding is constant as well as staining of underwear. This bleeding is sometimes very heavy and a burning sensation in the anal area is also common.

Grade 3 and grade 4 internal haemorrhoids are the most bothersome, and the only ones for which surgical treatment is the only solution.

As we have been saying, it is possible to resort to different treatments to solve the problems caused by the inflammation of internal haemorrhoidal veins. In mild cases, it is possible to resort to drugs, ointments and specific care. Or, on the other hand, you can opt for haemorrhoid surgery, either by the conventional method, removal, or laser haemorrhoid surgery.

• García Gutiérrez, A. (2001, marzo). Hemorroides. Clasificación, diagnóstico y tratamiento. http://scielo.sld.cu/pdf/cir/v47n1/cir17108.pdf
• Consenso de Hemorroides (Vol. 16, Nos. 1 a 3). (2010, enero). Revista Mexicana de Coloproctología. https://www.medigraphic.com/pdfs/proctologia/c-2010/c101-3a.pdf