Symptoms of Hemorrhoids

Hemorrhoids are a common condition caused by varicose veins around the anus and rectum. Their symptoms vary among individuals; mild cases may only cause slight discomfort, while severe cases can impact daily life. Understanding the characteristic symptoms of hemorrhoids can help patients initiate early self-management or seek medical assistance to prevent disease progression. The following sections analyze the types of symptoms, development process, and criteria for medical consultation in stages.

The symptoms of hemorrhoids are mainly related to venous dilation, tissue swelling, and injury. Common symptoms include bleeding, pain, and foreign body sensation, but some patients may not notice abnormalities in the early stages. The severity of symptoms is usually closely related to the grading, location, and complications of hemorrhoids. Recognizing these symptom patterns early can help grasp the timing of treatment and reduce the need for surgery.

Early Symptoms and Signs

The initial stage of hemorrhoids may present only subtle signs, often mistaken for general gastrointestinal discomfort. Typical early symptoms include:

• Intermittent rectal bleeding: Bright red blood on toilet paper after defecation, usually in small amounts and not persistent, possibly accompanied by mild stinging sensation at the end of bowel movement.
• Itching around the anus (Pruritus ani): caused by secretions from hemorrhoids irritating the skin, leading to persistent itching around the anus, which may be accompanied by skin redness and swelling.
• Mild swelling sensation: feeling of fullness around the anus after bowel movements, which can be relieved by lying down and resting. This indicates temporary engorgement of internal hemorrhoidal veins.

This stage of symptoms may recur over weeks to months, but patients often overlook them due to mild discomfort, leading to gradual disease worsening. It is recommended to perform a preliminary anal examination if intermittent bleeding occurs more than three times.

Common Symptoms

As hemorrhoids progress to moderate stages, symptoms become more apparent and frequent. The main symptoms can be divided into four categories:

1. Bleeding-related symptoms

Rectal bleeding is the most common symptom of hemorrhoids, observed in about 90% of patients during defecation. The blood is usually bright red and adheres to the surface of the stool, related to mucosal injury of hemorrhoids. The bleeding can be categorized as:

• Drop-like bleeding: blood drops directly fall into the toilet during defecation
• Wiping bleeding: noticeable red blood on toilet paper
• Splashing bleeding: severe internal hemorrhoids may cause blood to spurt like a fountain during defecation

2. Pain and pressure sensation

External hemorrhoids or thrombosed hemorrhoids often cause severe pain. Characteristics include:

• Persistent burning pain: caused by nerve stimulation in the skin
• Increased pain with activity: walking or prolonged sitting worsens due to pressure changes
• Tenderness: touching a hard lump around the anus triggers pain

Disease Progression and Symptom Changes

The development of hemorrhoids typically involves three stages: "intermittent → persistent → complication stage." In the second stage, patients may experience the following progression:

In the third stage, hemorrhoids may prolapse outside the anus after defecation and need manual reduction. In the fourth stage, hemorrhoids are continuously exposed outside and cannot be repositioned, possibly complicated by infection or thrombosis. Symptoms at this stage include:

• Persistent external protrusion: hemorrhoids protruding like grapes outside the anus
• Secretion infiltration: mucus and tissue fluid leakage causing skin erosion
• Change in pain quality: from dull ache to severe pressure pain

About 30% of patients in stages three and four may experience secondary complications, such as secondary infection leading to abscess formation or chronic bleeding causing anemia symptoms (e.g., dizziness, fatigue).

When to Seek Medical Attention

The following symptoms suggest that hemorrhoids may have progressed to a stage requiring professional diagnosis and treatment, and immediate medical consultation is advised:

• Persistent bleeding lasting more than one week without self-resolution
• Single episode of bleeding exceeding 50cc (blood completely soaked into toilet paper)
• Painful hard lumps around the anus accompanied by fever
• Signs of anemia: such as pale nails, dizziness, and lightheadedness

Special populations such as pregnant women, diabetics, or those on anticoagulants should seek early medical evaluation even with mild symptoms. Doctors usually diagnose through digital rectal examination, anoscopy, or ultrasound, and develop treatment plans based on symptom severity.

It is important to distinguish hemorrhoids from other anal diseases: if bleeding is dark red or black, accompanied by abdominal pain and weight loss, other gastrointestinal issues may be involved, requiring further digestive tract examinations. Timely medical evaluation can effectively prevent misdiagnosis and worsening complications.

 

Frequently Asked Questions

When should I consider surgical treatment for hemorrhoids?

When hemorrhoids recurrently bleed, prolapse and cannot be manually reduced, or conservative treatments (such as medication and sitz baths) are ineffective, surgery may be recommended by a doctor. Severe thrombosed hemorrhoids or those causing intense pain are also commonly treated with surgery.

Which foods in daily diet may worsen hemorrhoid symptoms?

High-fat, spicy foods, and processed foods may irritate the intestines, worsen constipation, and thus increase bleeding or swelling of hemorrhoids. It is advisable to increase dietary fiber (such as whole grains and vegetables) and water intake to soften stool and reduce anal pressure.

What types of non-surgical medications are available for hemorrhoid treatment?

Topical ointments or suppositories containing zinc oxide or steroids can reduce inflammation and itching; oral medications that promote venous circulation can improve blood stasis. Local anesthetic gels can temporarily relieve pain but should be used according to medical instructions.

How can people with sedentary jobs prevent hemorrhoid worsening?

Take a break every 30 to 60 minutes to stand and move for 5 minutes, avoid prolonged sitting that increases abdominal pressure. Using supportive cushions to disperse pressure and pelvic floor exercises to strengthen local muscles can effectively reduce the risk of hemorrhoids.

Why does hemorrhoid prolapse sometimes produce foul-smelling secretions?

Prolonged exposure of hemorrhoidal tissue outside the anus may lead to bacterial growth due to incomplete cleaning, causing infection or tissue necrosis. At this point, secretions may have an odor. If accompanied by redness, swelling, and persistent bleeding, immediate medical evaluation and possible surgical removal are recommended.