Symptoms usually depend on the type of hemorrhoids a patient has. There are two types of nerves in the anal canal, visceral (above the dentate line) and somatic (below the dentate line). The somatic nerves are like the nerves of the skin and are capable of sensing pain. The visceral nerves are like the nerves of the intestines and do not sense pain, only pressure. Therefore, internal hemorrhoids, which are above the dentate line, usually are painless. But straining or irritation from passing stool can injure a hemorrhoid's delicate surface and cause it to bleed. You may notice small amounts of bright red blood on your toilet tissue or in the toilet bowl water. Many people consider that anus bleeding is the basic symptom. However, researchers have proved that hemroids usually bleed only in advance stage. Occasionally, straining can push an internal hemorrhoid through the anal opening. If a hemorrhoid remains displaced (prolapsed), it can cause pain and irritation, it secretes mucus and moistens the anus and the surrounding skin. Stool also can leak onto the anal skin. The presence of stool and constant moisture can lead to anal itchiness, although itchiness is not a common symptom of hemorrhoids. External hemorrhoids can be felt as bulges at the anus, but they usually cause few of the symptoms that are typical of internal hemorrhoids. External hemorrhoids tend to be painful. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), causing severe pain, swelling, burning sensation and inflammation. When irritated, external hemorrhoids can itch or bleed.
For convenience in describing the severity of internal hemorrhoids, many physicians use a grading system:
- First-degree hemorrhoids: Hemorrhoids that bleed but do not prolapse.
- Second-degree hemorrhoids: Hemorrhoids that prolapse and retract on their own (with or without bleeding).
- Third-degree hemorrhoids: Hemorrhoids that prolapse but must be pushed back in by a finger.
- Fourth-degree hemorrhoids: Hemorrhoids that prolapse and cannot be pushed back in. Fourth-degree hemorrhoids also include hemorrhoids that are thrombosed (containing blood clots) or that pull much of the lining of the rectum through the anus.
Merely acquiring knowledge of hemorrhoids symptoms is not sufficient to avoid or cure occurrence of hemorrhoids. What is required is proper observation of these symptoms and timely treatment.