Different types of hemorrhoids and how long they last

Hemorrhoids are a common, but uncomfortable condition. They occur when the veins in the lower rectum and anus become swollen leading to pain, bleeding, or itching. There are several types of hemorrhoids, and they can occur internally or externally.

Hemorrhoids affect one in 20 people in the U.S. of all ages, and half of the adults aged 50 and older. Here’s everything you need to know about this condition.

Different types of hemorrhoids

There are several types of hemorrhoids that are identified based on their location and severity. They can be internal or external hemorrhoids, can have no symptoms, or be severe and require surgery. 

The types of hemorrhoids include: 

Internal hemorrhoids

Internal hemorrhoids happen inside the anal canal. These hemorrhoids don’t tend to cause discomfort, but they often cause painless rectal bleeding.

External hemorrhoids

External hemorrhoids affect the veins on the outside of the anus. This type of hemorrhoid often causes rectal itching or pain. External hemorrhoids appear as distended veins or lumps. In fact, “piles,” an antiquated term for hemorrhoids, comes from the Latin word “pila,” which means “ball.”

Prolapsed hemorrhoids

Prolapsed hemorrhoids occur when an internal hemorrhoid protrudes through the anus. These hemorrhoids cause symptoms similar to external hemorrhoids. Prolapsed hemorrhoids are classified as Grade 1, 2, 3, or 4, depending on how severe they are.  Grade 4 prolapsed hemorrhoids are the most problematic and often require surgical intervention.

Perineum hemorrhoids

Depending on their location, some hemorrhoids can put pressure on the perineum which can cause pain in the rectum. Pain may be worse surrounding a bowel movement. This type of hemorrhoid may require surgery to help improve the pain. 

The difference between internal vs. External hemorrhoids

Hemorrhoids can occur anywhere along the anal canal either inside or on the outside. The only sign of an internal hemorrhoid is usually painless anal bleeding. External hemorrhoids are generally associated with pain or anal itching.

Internal hemorrhoids grade scale 1-4

Internal hemorrhoids are evaluated based on how far they protrude (prolapse) outside the anus. A healthcare provider can evaluate where the hemorrhoid is located based on a physical exam. 

Grade 1: Hemorrhoid protrudes internally into the anal canal but does not prolapse to the outside. 

Grade 2: Hemorrhoid protrudes only during straining or a bowel movement, but returns inside the canal on its own. 

Grade 3: Hemorrhoid protrudes during straining or a bowel movement, but must be pushed back inside manually.

Grade 4: Hemorrhoid is prolapsed outside the anal canal. 

Grades 3 and 4 generally require surgery or more serious treatment options.

External thrombosed hemorrhoids 

Thrombosed external hemorrhoids occur when a blood clot is lodged in a vein in the anus or lower rectum. This type of hemorrhoid often causes pain and bleeding. Patients often undergo a procedure called a thrombectomy in which the vein is cut open and the blood clot is removed.

How do I know what type of hemorrhoids I have? 

It can be challenging to know what type of hemorrhoids you have on your own. If you suspect you have hemorrhoids or are experiencing severe itching or pain, it is best to be evaluated by a healthcare provider. Generally, this starts with a visual exam which can help diagnose external or prolapsed hemorrhoids.

If an internal hemorrhoid is suspected, this may require a digital rectal exam or an imaging scope. The rectal exam involves inserting a gloved finger into the anus to look for signs of hemorrhoids. If a digital exam is unclear, the doctor may insert a thin tube with a light on the end, called a scope, to help make the correct diagnosis.

Who is at risk for hemorrhoids?

People who strain while having a bowel movement or sit on the toilet for long periods of time are at a higher risk of hemorrhoids.

Obesity and pregnancy also increase the risk of hemorrhoids because abdominal weight puts pressure on the veins in the anal canal. Heavy lifting, anal sex, and chronic diarrhea or constipation can lead to hemorrhoids as well.

There’s also evidence that hemorrhoids can be genetic, since people whose parents have hemorrhoids are at an increased risk of forming hemorrhoids, too.

How long do hemorrhoids last?

Hemorrhoids can be uncomfortable or even painful, so you may be wondering do hemorrhoids go away? Yes, depending on the location and severity of the hemorrhoid it can resolve quickly with at-home treatment.

Treatment will depend on the type of hemorrhoids, symptoms, and severity. In mild cases, increasing your fiber and water intake can alleviate the problem within a few days. In other cases, topical over-the-counter and prescription medications are indicated. In severe cases, surgery may be required to resolve the problem.

There are several steps you can take to prevent hemorrhoids

Eating a high-fiber diet can minimize your risk of hemorrhoids since fiber and water soften stool and reduce constipation. The average adult in the U.S. only gets 10-15 grams of fiber in their diet daily. To prevent hemorrhoids (and other gastrointestinal conditions), aim to get at least 25 grams of fiber every day. Fresh fruits, vegetables, legumes, beans, and whole grains are all fiber-rich options.  Fiber supplements are also available for people who don’t get enough fiber from their diet.

In addition, drinking plenty of water, avoiding unnecessary heavy lifting, maintaining a healthy weight, and using plenty of lubricants if you engage in anal sex can also lower your risk of hemorrhoids.

Visit urgent care for hemorrhoid treatment

If you need help assessing and treating your hemorrhoids, visit one of our urgent care centers. You can walk in without an appointment, or you can check in online. We specialize in convenient care for the whole family. We’ll have you back to feeling better in no time.

Sources:

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/haemorrhoids

https://my.clevelandclinic.org/health/diseases/15120-hemorrhoids

Written by Sarah Thebarge, Physician Assistant