![]() As this is arterial blood, it will usually be bright red in colour and may appear as streaks on toilet paper when wiping, on the surface of stools, or in the toilet water . GP referral to exclude other diagnoses should be made if the blood has a different appearance, such as darker red, brown or black, or is mixed with the stool. Where bleeding is present, this will typically occur after bowel motions because of the microtrauma of passing hard stools. ![]() Pain is not usually reported with internal haemorrhoids unless the haemorrhoid is prolapsed and strangulated the latter occurring when the blood supply has been cut off by pressure applied from the anal muscles . Prolapsed haemorrhoids may become itchy and irritated owing to the presence of moisture, mucus and faecal matter. Further straining should be avoided to prevent haemorrhoids from prolapsing . Symptoms of internal haemorrhoids will commonly include a feeling of discomfort and a sensation of fullness in the rectum or incomplete evacuation, especially after passing stools. The latter is a result of irritation from faecal matter not being fully removed upon wiping . Pain is uncommon unless very severely swollen owing to thrombosis . Internal haemorrhoids are graded by degree of prolapse using Goligher staging, although classification does not always reflect the severity of the symptoms ( see Figure 2) . Internal and external haemorrhoids can be present at the same time .įigure 2: Goligher staging of haemorrhoidsĮxternal haemorrhoids are often described as lumps and bumps around the anus with itching. Internal haemorrhoids arise above the dentate line and are covered by columnar epithelium, which have no pain fibres. External haemorrhoids originate below the dentate line and are covered by modified squamous epithelium, which is richly innervated with pain fibres ( see Figure 1). ![]() Haemorrhoids are classified as external or internal depending on their position in relation to the dentate line (dividing the upper two-thirds from the lower third of the anal canal). Certain toilet behaviours, such as straining or spending more time on a seated toilet than on a squat toilet squatting provides a better angle for defecation . ![]()
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