Depending on their location in the anus, we distinguish two types of hemorrhoids:
- External hemorrhoids: these are those veins that are located in the part of the anus covered by skin, so they remain in the “visible” part. When these veins are thrombosed by a defecatory effort, a purplish-blue lump appears in the anal region causing pain to the patient. This is known as hemorrhoidal thrombosis. This type of hemorrhoids do not usually bleed (since they are covered with skin, and the skin protects), they only do so in cases of very acute thrombosis, in which the pressure of the hematoma causes a skin ulcer with the exit of a clot and bleeding.
- Internal hemorrhoids: are those that remain in the inner part of the anus, so they are not visible under normal conditions. They are not covered with skin, but with mucosa, and are much more vulnerable to friction and pressure. They usually manifest themselves with bleeding or a sensation of heaviness. As the years go by, they slide outwards and are exposed to external friction; it is then when they erode and bleed.
Classification of hemorrhoids
Hemorrhoids are classified on the basis of internal hemorrhoids, not external hemorrhoids. We distinguish 4 different types:
- Grade I: bleeding with bowel movements, dilatation of the internal hemorrhoidal bundles (without coming out); they cause itching and a feeling of heaviness.
- Grade II: prolapse of the hemorrhoids to the outside during bowel movements, but then they return to their position. They cause itching and a sensation of occupation in the rectum.
- Grade III: bleeding, prolapse during bowel movements; the patient must help to reintroduce them with manual pressure, toilet paper or by sitting on something hard after going to the toilet. They cause itching, pain and sometimes staining of underwear.
- Grade IV: remain on the outside most of the day, and cause bleeding, constant oozing, staining of underwear and burning sensation.
For more information consult your coloproctologist.