Hemorrhoids are dilations of the veins located in the submucosa of the anal canal which plays a physiological role in incontinence by contributing to the closure of the anal opening. We distinguish under the name of hemorrhoids, the attack of two distinct vascular structures:
The external hemorrhoidal plexus, the involvement of which forms external hemorrhoids.
The internal hemorrhoidal plexus, the involvement of which forms internal hemorrhoids.
Causes of hemorrhoids
A hemorrhoidal crisis can originate from Intestinal transit disorders (constipation or diarrhea); In women: premenstrual phase, pregnancy, childbirth … (See also our article on hemorrhoids during pregnancy) Physical inactivity.
Other contributing factors have a discussed responsibility:
Some sports: cycling, horse riding … The professions exposed: drivers, pilots … Food: spices, alcohol … Certain drugs: antidepressants … Local medicines: suppositories, enemas, irritating soap …
Signs of a hemorrhoidal crisis
External and internal hemorrhoids
External hemorrhoids are visible below the anus. Internal hemorrhoids are only visible during an anoscopy. They may show no symptoms, or protrude, continuously or with pushing or straining, into the anal canal. Common symptoms Hemorrhoidal disease can clinically result in three types of signs that are already complications: Bleeding or rectal bleeding;
The perception of a lump in the anus; Anal pain; Itches. Rectal bleeding Hemorrhoidal bleeding is typically made of shiny red blood that occurs at the end of a bowel movement. Usually scarce, it stains the toilet paper or splashes the toilet bowl. It can be the cause of anemia by its recurrence. The bright red appearance of the bleeding means that the hemorrhoidal disease is more arterial than venous.
There are indeed important arteriovenous communications at the level of the plexuses. The anoscopy reveals a congestive mucosa traversed by fine red vessels. Even though hemorrhoids are one of the most common causes of rectal bleeding, a colonoscopy always looks for more diseases.
Perception of an anal ball
Hemorrhoidal procidence is the exteriorization of internal hemorrhoids. The patient then consults for a lump coming out of the anal canal during bowel movements, during exertion, or permanently. The proctological examination allows a classification of the procidence according to the evolutionary stage guiding the therapeutic indications:
Stage I. Hemorrhoids protruding into the anal canal during pushing efforts without externalizing;
Stage II. Hemorrhoids externalizing with effort but re-entering the anal canal spontaneously;
Stage III. Hemorrhoids exteriorizing with effort but re-entering the anal canal after finger pressure;
Stage IV. Permanent haemorrhoidal prolapse. The perception of a lump in the anus can also correspond to a hemorrhoidal thrombosis but in this case, it is especially for the anal pain that the patient consults.
Permanent, it directs towards a thrombosis or an abscess; pulsatile, it checks for an abscess. Caused by defecation, it points to an anal fissure.
Thrombosis is a common complication of hemorrhoids. It poses different practical problems depending on whether it is located at the level of the external or internal hemorrhoidal plexuses. It is in fact more often the constitution of a hematoma rather than a true thrombosis. There is no risk of pulmonary embolism and the course is always benign.
External hemorrhoidal thrombosis is the most common. Typically it begins suddenly with intense anal pain, permanent, present at night, independent of stool, sometimes preventing the sitting position. Upon inspection of the anal margin, the doctor notes a subcutaneous swelling, bluish, hard, and painful on pressure, corresponding to the clot, sometimes associated with edema.
The immediate evolution is towards the disappearance of the symptoms in a few days. Sometimes spontaneous necrosis of the sac containing the clot causes bleeding which relieves the patient.