Internal Anal Sphincter Hemorrhoids

Hemorrhoids, commonly known as piles, are swollen veins in the lower rectum and anus. Internal anal sphincter hemorrhoids specifically occur inside the anal canal, above the dentate line. They can cause discomfort, bleeding, and other symptoms. This guide provides detailed information about internal anal sphincter hemorrhoids, including their anatomy, types, causes, symptoms, diagnostic methods, treatments, prevention, and frequently asked questions.

Internal anal sphincter hemorrhoids are swollen blood vessels located inside the anus. They lie above the dentate line, where the sensitive mucous membrane meets the less sensitive skin. Unlike external hemorrhoids, internal ones are typically painless but can bleed during bowel movements.

Anatomy of the Anal Region

Structure

The anal canal is the final part of the digestive tract. It is surrounded by muscles called sphincters:

• Internal Anal Sphincter: Involuntary muscle controlling stool passage.
• External Anal Sphincter: Voluntary muscle for additional control.

Blood Supply

Hemorrhoids receive blood through the superior, middle, and inferior rectal arteries. Internal hemorrhoids are primarily fed by the superior rectal arteries.

Nerve Supply

Internal hemorrhoids are less sensitive to pain because they are innervated by autonomic nerves. External hemorrhoids have more pain receptors, making them more sensitive to pain.

Types of Hemorrhoids

Hemorrhoids are classified based on their location and degree:

1. Internal Hemorrhoids:
   • Located inside the anus.
   • Classified from Grade I to IV based on prolapse:
     • Grade I: No prolapse.
     • Grade II: Prolapse with straining but reduce spontaneously.
     • Grade III: Prolapse with straining and require manual reduction.
     • Grade IV: Prolapsed and cannot be manually reduced.
2. External Hemorrhoids:
   • Located under the skin around the anus.
   • More likely to cause pain and swelling.
3. Mixed Hemorrhoids:
   • Features of both internal and external hemorrhoids.

Causes of Internal Anal Sphincter Hemorrhoids

Internal hemorrhoids develop due to increased pressure in the rectal veins. Here are 20 potential causes:

1. Straining During Bowel Movements
2. Chronic Constipation
3. Chronic Diarrhea
4. Sitting for Long Periods
5. Pregnancy
6. Obesity
7. Low-Fiber Diet
8. Aging
9. Heavy Lifting
10. Genetic Predisposition
11. Anal Intercourse
12. Prolonged Standing
13. Liver Disease
14. Frequent Coughing or Sneezing
15. Dehydration
16. Lack of Exercise
17. Poor Posture
18. Certain Medications
19. Trauma to the Anal Area
20. Hormonal Changes

Symptoms of Internal Anal Sphincter Hemorrhoids

Internal hemorrhoids often present with subtle signs. Here are 20 possible symptoms:

1. Painless Rectal Bleeding
2. Bright Red Blood on Toilet Paper
3. Blood in Stool
4. A Lump in the Anus
5. Itching Around the Anus
6. Mucus Discharge
7. Feeling of Incomplete Evacuation
8. Discomfort During Bowel Movements
9. Prolapse of Hemorrhoid
10. Swelling Around the Anus
11. Burning Sensation
12. Pain During Prolapse (if it becomes external)
13. Bleeding After Bowel Movements
14. Sensation of Fullness
15. Bleeding When Wiping
16. Visible Hemorrhoid on Inspection
17. Discoloration of Skin Around Anus
18. Pain During Sitting (if prolapsed)
19. Difficulty Cleaning After Bowel Movements
20. Anemia (in severe bleeding cases)

Diagnostic Tests for Hemorrhoids

Doctors use various methods to diagnose internal hemorrhoids. Here are 20 diagnostic tests and procedures:

1. Physical Examination
2. Digital Rectal Exam
3. Anoscopy
4. Proctoscopy
5. Sigmoidoscopy
6. Colonoscopy
7. Thanoscope Examination
8. Ultrasound
9. CT Scan
10. MRI
11. Flexible Sigmoidoscopy
12. Endorectal Ultrasound
13. Biopsy (if cancer is suspected)
14. Defecography
15. Venography
16. Anorectal Manometry
17. pH Testing
18. Virtual Colonoscopy
19. Flexible Endoscopic Evaluation of Swallowing (FEES)
20. Infrared Imaging

Note: Not all these tests are commonly used for hemorrhoids. Typically, a physical exam, anoscopy, or proctoscopy suffices.

Non-Pharmacological Treatments

Managing internal hemorrhoids often involves lifestyle changes and home remedies. Here are 30 non-drug treatments:

1. Increase Dietary Fiber
2. Stay Hydrated
3. Regular Exercise
4. Avoid Straining
5. Use of Squatting Position
6. Warm Sitz Baths
7. Cold Compresses
8. Good Bathroom Habits
9. Avoid Prolonged Sitting
10. Elevate Feet During Bowel Movements
11. Maintain Healthy Weight
12. Avoid Heavy Lifting
13. Increase Physical Activity
14. Use Moist Wipes Instead of Toilet Paper
15. Gentle Cleaning After Bowel Movements
16. Don’t Delay Bowel Movements
17. Wear Loose-Fitting Clothing
18. Use Cushioning When Sitting
19. Practice Kegel Exercises
20. Limit Spicy Foods
21. Reduce Caffeine Intake
22. Avoid Alcohol
23. Use Stool Softeners
24. Apply Aloe Vera
25. Use Witch Hazel
26. Maintain Regular Sleep Schedule
27. Manage Stress
28. Avoid Holding Breath During Strain
29. Proper Posture
30. Regular Medical Check-ups

Medications for Hemorrhoids

When lifestyle changes aren’t enough, medications can help manage symptoms. Here are 20 drugs used for hemorrhoids:

1. Topical Hydrocortisone
2. Witch Hazel Pads
3. Preparation H Cream
4. Anusol Cream
5. Tucks Medicated Pads
6. Glycerin Suppositories
7. Pain Relievers (Ibuprofen, Acetaminophen)
8. Stool Softeners (Docusate Sodium)
9. Fiber Supplements (Psyllium Husk)
10. Vasoconstrictors
11. Lidocaine Creams
12. Nitroglycerin Ointment
13. Topical Lidocaine
14. Phenylephrine Cream
15. Beta-Blockers (for severe cases)
16. Topical Rutosides
17. Anti-inflammatory Creams
18. Protective Barriers (Petrolatum)
19. Astringents
20. Hemorrhoidal Creams with Multiple Ingredients

Note: Always consult a healthcare provider before using any medication.

Surgical Treatments

In severe cases, surgery may be necessary. Here are 10 surgical options:

1. Rubber Band Ligation
2. Sclerotherapy
3. Infrared Coagulation
4. Hemorrhoidectomy
5. Stapled Hemorrhoidopexy
6. Doppler-Guided Hemorrhoidal Artery Ligation (DG-HAL)
7. Laser Therapy
8. Cryotherapy
9. Electrocoagulation
10. Hemorrhoidal Artery Ligation

Note: The choice of surgery depends on the severity and type of hemorrhoids.

Prevention of Hemorrhoids

Preventing hemorrhoids involves maintaining healthy bowel habits and lifestyle. Here are 10 prevention tips:

1. Eat a High-Fiber Diet
2. Drink Plenty of Water
3. Exercise Regularly
4. Avoid Straining During Bowel Movements
5. Don’t Delay Going to the Bathroom
6. Maintain a Healthy Weight
7. Avoid Prolonged Sitting
8. Use Proper Lifting Techniques
9. Practice Good Hygiene
10. Incorporate Fiber Supplements if Needed

When to See a Doctor

Seek medical attention if you experience:

1. Bleeding During Bowel Movements
2. Severe Pain
3. Persistent Itching or Irritation
4. A Lump Near the Anus
5. Discharge from the Anus
6. Signs of Infection (Fever, Redness)
7. Difficulty Reducing a Prolapsed Hemorrhoid
8. Anemia Symptoms (Fatigue, Weakness)
9. Blood in Stool
10. Sudden Onset of Symptoms
11. Symptoms Not Improving with Home Treatment
12. Chronic Constipation or Diarrhea
13. Swelling or Lump That Won’t Go Away
14. Change in Bowel Habits
15. Unexplained Weight Loss
16. Persistent Discomfort
17. Bleeding Not Related to Bowel Movements
18. Recurring Hemorrhoids
19. Difficulty Controlling Bowel Movements
20. Painful Bowel Movements
21. Bleeding in Young Individuals
22. Bleeding Without Visible Hemorrhoids
23. Family History of Colon Cancer
24. History of Radiation Therapy in Pelvic Area
25. Chronic Liver Disease Symptoms
26. History of Blood Clotting Disorders
27. Previous Hemorrhoid Surgery Complications
28. Presence of Other Rectal Conditions
29. Persistent Discomfort After Treatment
30. Any New or Worsening Symptoms

Frequently Asked Questions

1. What are internal anal sphincter hemorrhoids?

Swollen veins inside the anus that can cause bleeding and prolapse without significant pain.

2. How do internal hemorrhoids differ from external ones?

Internal hemorrhoids are inside the anal canal and usually painless, while external hemorrhoids are under the skin around the anus and can be painful.

3. What causes internal hemorrhoids?

Increased pressure in rectal veins from straining, constipation, pregnancy, obesity, and other factors.

4. Can internal hemorrhoids heal on their own?

Yes, mild cases may improve with home treatments like dietary changes and proper hygiene.

5. How are internal hemorrhoids diagnosed?

Through physical exams, anoscopy, proctoscopy, or other diagnostic procedures.

6. What treatments are available for internal hemorrhoids?

Lifestyle changes, medications, non-surgical procedures, and surgeries for severe cases.

7. Are internal hemorrhoids cancerous?

No, hemorrhoids are benign, but similar symptoms can be caused by cancer, so medical evaluation is essential.

8. Can diet affect hemorrhoids?

Yes, a high-fiber diet helps prevent and manage hemorrhoids by softening stools and reducing straining.

9. When is surgery necessary for hemorrhoids?

When non-surgical treatments fail, or in cases of severe prolapse, bleeding, or pain.

10. Can exercise prevent hemorrhoids?

Regular exercise promotes healthy bowel movements and reduces pressure on veins, helping prevent hemorrhoids.

11. What is rubber band ligation?

A procedure where a rubber band is placed around the hemorrhoid base to cut off blood flow, causing it to shrink.

12. Are there natural remedies for hemorrhoids?

Yes, warm baths, witch hazel, aloe vera, and dietary changes can help manage symptoms.

13. How long does it take for hemorrhoids to heal?

With proper treatment, symptoms may improve within a few days to weeks.

14. Can hemorrhoids recur?

Yes, especially if underlying causes like constipation or poor diet are not addressed.

15. Is surgery for hemorrhoids painful?

Post-surgery pain is common but manageable with medications. Recovery time varies based on the procedure.

Conclusion

Internal anal sphincter hemorrhoids are a common condition that can cause discomfort and bleeding. Understanding their anatomy, causes, symptoms, and treatment options can help manage and prevent them effectively. If you experience persistent or severe symptoms, consult a healthcare professional for proper diagnosis and treatment.

 

Authors Information

 

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