General Practice 2022

Internal hemorrhoids: what they are, main symptoms and degrees

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Internal hemorrhoids: what they are, main symptoms and degrees
Internal hemorrhoids: what they are, main symptoms and degrees

Internal hemorrhoids correspond to dilated veins inside the rectum that are not seen in the anus, and are often diagnostic when the presence of bright red blood in the stool or toilet paper is observed when defecating, itching and discomfort in the anus, which makes going to the bathroom difficult.

Internal hemorrhoids can be classified in degrees according to the symptoms presented, which also interferes with the treatment recommended by the proctologist. Regardless of the degree of internal hemorrhoid, it is important to change eating habits, giving preference to foods rich in fiber, as it is possible to relieve symptoms and reduce pain and discomfort at the time of evacuation.

Main symptoms

Although the internal hemorrhoid is not visible, the signs and symptoms that appear are characteristic, with mainly the presence of bright red blood in the stool. In addition, other signs and symptoms that may be indicative of internal hemorrhoids are:

  • Itchy anus;
  • Outflow of mucus from the anus;
  • Difficulty and pain to defecate;
  • Anal discomfort;
  • Anal tenesmus, which corresponds to the intense urge to evacuate even though there is no more fecal content to be eliminated;
  • Feeling of incomplete emptying of the rectum after defecation.

In addition, it is also possible to notice the appearance of a small nodule in the anus during evacuation and that may or may not return naturally to the initial location, this nodule corresponding to the dilated veins that come out of the anus, characterizing hemorrhoids internal grade 2, 3 or 4, depending on the characteristics.

How to confirm the diagnosis

The diagnosis of internal hemorrhoids must be made by the gastroenterologist or by the proctologist through a proctological examination, in which the doctor will evaluate the anal region in order to identify any alteration that is indicative of internal hemorrhoids. To perform the exam, the doctor indicates the position that the person should be in and then analyzes the anus, being indicated for the person to make an effort as if he were defecating, as this way it is possible to verify the presence of hemorrhoids or anal fissures.

In addition to the proctological examination, the doctor also evaluates the symptoms presented and the person's history, especially with regard to eating habits and physical activity, because unhe althy diet and sedentary lifestyle favor the appearance of hemorrhoids.

Grades of internal hemorrhoids

According to the symptoms presented, internal hemorrhoids can be classified into 4 degrees, which influences the treatment recommended by the doctor:

  • Grade 1 internal hemorrhoid: only bleeding is checked and the veins do not come out of the anus;
  • Grade 2 internal hemorrhoids: veins come out of the anus during evacuation, but return to their original position naturally, and there is also bleeding;
  • Grade 3 internal hemorrhoid: there is also bleeding and the veins only return to their normal position when they are carefully pushed;
  • Grade 4 internal hemorrhoids: there is heavy bleeding and the prolapse is irreducible, that is, they do not return to their original position even when pushed.

According to the symptoms presented and the characteristics verified by the gastroenterologist or proctologist, the degree of hemorrhoid can be indicated and treatment started immediately afterwards.

It is important to go to the doctor when any signs or symptoms indicative of internal hemorrhoids are observed, as it is possible for the doctor to start the diagnostic process.Initially, the diagnosis is made by evaluating the symptoms and the person's evacuation and eating habits, history of laxative use, and history of surgeries and gastrointestinal diseases. Then, the proctological diagnosis must be performed, which consists of observing the anus in order to identify any alteration.

Main causes

The appearance of internal hemorrhoids is often related to a person's habits, such as a low-fiber diet, frequent use of laxatives, the habit of sitting on the toilet for a long time, smoking and a sedentary lifestyle. In addition, inadequate nutrition causes intestinal transit to be impaired, in addition to making the feces more dry, which makes it necessary for the person to exert excessive force to evacuate, leading to the formation of hemorrhoids.

Internal hemorrhoids can also be related to local infections, be a consequence of chronic diarrhea or happen during pregnancy, which is very common due to the increase in body weight and pressure exerted on the pelvic region by the baby.Understand why hemorrhoids appear in pregnancy and how to treat them.

How to be treated

Treatment for internal hemorrhoids should be guided by the proctologist according to the degree of hemorrhoid, and change in eating habits may be recommended, giving preference to foods rich in fiber, consumption of plenty of fluids during the day, sitz bath, use of pain relievers and anti-inflammatories such as Naproxen, or use of hemorrhoid ointments such as Proctyl or Ultraproct. Other treatment options that may be recommended by the doctor according to the degree of hemorrhoid are sclerotherapy, photocoagulation, cryotherapy and use of elastic bandages. Understand how treatment for internal hemorrhoids is done.

In more serious cases, in which the hemorrhoid is stuck in the anus, there is a risk of clot formation that can cause hemorrhoidal thrombosis and, therefore, the doctor may recommend surgery to repair the dilated veins.

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