Internal and external hemorrhoids

Written by: Dra. María Antonia Lequerica Cabello
Published: | Updated: 21/11/2018
Edited by: Top Doctors®

Hemorrhoidal tissue is a normal component of human anatomy. It is a thickening of the submucosa of the anal canal (final part of the rectum) that contains a combination of venous and arterial vessels, smooth muscle and supporting tissue that acts as a pad and contributes to a more effective closure of the anus.. When said tissue hypertrophies, prolapses externally and produces a more or less severe symptomatology, it is when it receives the name of hemorrhoids.

Types of hemorrhoids

On the one hand, external Hemorrhoids, visible around the anus and covered with skin and, on the other hand, internal Hemorrhoids not visible when placed above the anus, inside the rectum and covered with mucosa.

Hemorrhoids become a health problem when they give symptoms to the patient. The most common and initial bleeding is but later they can evolve and cause pain, itching, spotting of underwear, thrombosis.


Internal hemorrhoids are classified in 4 grades:

- Grade I : when defecating there is only bleeding.

- Grade II : protrude when defecating but reintroduce spontaneously when stopping defecatory effort.

- Grade III :: protrude when defecating but must be manually reintroduced

- Grade IV : they are irreducible and are always prolapsed.


Recommended habits

There is no single treatment for hemorrhoids or all patients with hemorrhoids should be operated on. Depending on the degree of hemorrhoids there are different therapeutic options.

In grades I, II and in the initial III, non-surgical treatment is carried out consisting of following one or several measures at a time.

First, dietary measures such as eating a minimum amount of fiber (fruit, vegetables, plantago-type additives, ovata ...), drinking plenty of liquids (1.5-2 liters / day) and suppressing foods with spices, spicy alcohol and coffee. On the other hand, do not spend more than 10 minutes in the toilet and do sitz baths with warm-hot water (3 or 4 a day with a duration of about 5 minutes).

These measures can be completed with the application of topical ointments that serve to reduce discomfort and inflammation. However, it should be taken into account that this type of product does not cure, in no case should be applied as usual since its continued use may cause anal dermatitis and skin atrophy. In addition, it is possible to resort to the venotonic ustancias, these are also purely symptomatic, not curative (Daflon, venoruton ...).

In the case of lower grade hemorrhoids (I and II) there are a number of non-surgical methods that, carried out in different sessions in the doctor's office, get, with little discomfort, the reduction of hemorrhoids. These methods include: injection of sclerosing substances or coagulation with either infrared or non-surgical laser. Currently the most used method is the ligature with elastic bands .

*Translated with Google translator. We apologize for any imperfection
Dra. María Antonia Lequerica Cabello

By Dra. María Antonia Lequerica Cabello

It is one of the best specialists in Coloproctologia and laparoscopic surgery of the colon, rectum and pelvic floor. Part of colorectal cancer multidisciplinary team of Chiron-Dexeus Hospital in Barcelona. Expert in complex surgery endometriosis, works well with the team of gynecology of Dexeus. Together with Dr. Centeno, leads the Unit Team Colorectal Surgeons Surgical Associates.

*Translated with Google translator. We apologize for any imperfection

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