Hemorrhoids are swollen veins in the anus and lower rectum. The veins around the anus tend to stretch under pressure, causing bulge or swelling. This condition can develop from increased pressure in the lower rectum. Hemorrhoids might develop in different locations at the same time. Classified by locations, there are 2 types of hemorrhoids:
1.) Internal hemorrhoids
Internal hemorrhoids lie inside the rectum which located above the pectinate line and are covered with cells that are the same as those that line the rest of the intestines. Internal hemorrhoids cannot be typically seen or felt. Only using endoscopy, proctoscopy and sigmoidoscopy allows gastroenterologists to examine the inner lining of the rectum. Internal hemorrhoids can be stratified into 4 grades:
Grade I: The internal hemorrhoid bulges into the canal but does not prolapse. These may cause rectal bleeding.
Grade II: The hemorrhoid protrudes through the rectum with straining during a bowel movement. But it spontaneously returns to their original position once the straining has subsided after bowel movements.
Grade III: The hemorrhoid protrudes without any straining and requires the patient to push it inside manually.
Grade IV: The hemorrhoid protrudes and cannot be pushed back, causing discomfort and rectal pain.
2.) External hemorrhoids
External hemorrhoids are hemorrhoids that affect veins outside the anus. External hemorrhoids arise below the pectinate line and are covered with cells that resemble skin which are typically slightly less pink than the surrounding skin. External bulges can be seen and touched around the anal area. Symptoms might include itching or irritation in the anal region, pain or discomfort, swelling around the anus and rectal bleeding.
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