This hemorrhoid “complex” is actually a normal part of the human anatomy, and is believed to have been helpful in passage of bowel movements in ancient humans. Today, however, hemorrhoids are largely considered vestigial (like the appendix), and become a problem when inflamed. There are some researchers who believe that normal hemorrhoids still help to control bowel movements, though we know that this is the primary function of the anal musculature, or sphincter.
If you’re reading this, however, chances are that your hemorrhoids are swollen, itching, painful or in the way of bowel movements. This is what we at Doctor Butler’s call a problem hemorrhoid.
Most patients first notice their hemorrhoids as sensitive, swollen blood vessels around the rim of the anus. These are called external hemorrhoids. External hemorrhoids are typically caused by internal hemorrhoids, or hemorrhoids located further up the anal cavity along the walls of the rectum, so treating internal hemorrhoids can help stop external flare ups.
The biggest source of hemorrhoids is internal pressure on the perineal area. So, because swollen hemorrhoids are typically related to some kind of pressure from the inside out, it follows that abnormal outside or “external” hemorrhoids are caused from the inside or “internal” hemorrhoids. This is why successful treatment of swollen external hemorrhoids primarily depends on reducing blood flow to internal hemorrhoids. Once internal hemorrhoids are adequately treated, external hemorrhoids usually respond as well.
Typical symptoms of problematic external hemorrhoids include the sudden development of a marbleized-like structure with associated discomfort. This is what is known as an external thrombotic hemorrhoid. This condition usually resolves itself within a few weeks’ time, though excision through surgery is possible for cases where there is significant pain.
That’s because the broken vessel causing the external blood clot comes from too much pressure internally. The other, more difficult to treat condition affecting chronic external hemorrhoids is recurring swelling causing small and large tags, or an excess soft growth of skin. In other words, the blood vessels in the hemorrhoids become swollen over and over again, stretching out the overlying skin. If the internal hemorrhoids causing pressure to the external hemorrhoids are treated early enough, tags can be prevented.
Sometimes, however, prolapsed internal hemorrhoids are frequently mistaken as external hemorrhoids. A prolapsed internal hemorrhoid is one that is so swollen and stretched out that it “falls out” of the anus. The prolapse can be treated if caught early enough by reducing circulation to the hemorrhoid site with a vasoconstrictor like Phenylephrine. This can reduce the size of the prolapsed internal hemorrhoid allowing it to recede back into the anus.
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Internal hemorrhoids can even trigger bowel habit changes and irritability since the nervous system will misinterpret signals being sent from the anus and rectum. In other words, the brain cannot tell the difference between large hemorrhoids and feces within the rectal vault causing many changes to occur in the gastrointestinal tract.