Internal hemorrhoids vs External hemorrhoids

One of the characteristics of anal anatomy is the presence of cushions. They are made up of small blood vessels, smooth muscles, and connective tissue. Due to the locations, combined with other factors, they can be enlarged and thus producing a lump, which we call as hemorrhoids. You might come across the confusions that occur when the term internal and external hemorrhoids come into play.

Before clarifying the grey line that has been long argued upon, it is paramount to know the principle behind the pain that we are feeling. Visceral nerve endings or connection of the nervous system of the internal organs would not be producing pain although there are injuries. On the other hand, somatic endings or the system of the skin is actively working to detect any harm inflicted to you so that pain can be sensed. You will notice the source causing it and subsequently dispose of or walking away from it. This is an important evolutionary trait because further curable damage can be prevented by mankind thanks to this programmed physiological process.

Anatomy of the anal includes a barrier that is being knowns as dentate line. It is a border separating the function of the mentioned visceral and somatic. One of the most distinct features that can help the doctors to identify between internal and external hemorrhoids is that the latter brings a painful experience to its patients. Hence, any piles (other names of hemorrhoids) originating near the skin and below the dentate line is supplied by the somatic nervous system is stated as external hemorrhoids. Meanwhile, lumps starting from the locations above the dentate line and away from the skin is internal hemorrhoids. There are however some exceptions to that. Internal hemorrhoids can still give out the pain when it merges with external hemorrhoids or associated with anal fissure.

In terms of other symptoms, both of them are quite different from each other too. Massive bright red bleeding during defecation, incomplete passing out of stool, itchiness, and feeling of fullness at the anus are the problems that one would have to endure when internal hemorrhoids take place. The most disturbing issue from them all is the first one. Should it is left ignored, depletion of blood from the body will follow and it is considered as a serious medical emergency.  Nevertheless, many people find that it is still a taboo to bring the problem forward because they are too shy and this is very dangerous. Furthermore, piles are not the only condition that can produce bleeding as other more sinister diseases can present in the same way such as colon cancer. It is then a life-saving step to promptly seek help from the doctors once this symptom arises.

As of external hemorrhoids, the magnitude of the problem is relatively lesser compared to its counterparts. Apart from the pain, it can cause irritations, bulge to the skin and skin tags. The vessels inside can also be clogged by blood clots creating a situation known as thrombosis. Once it occurs, the swelling would become hard.

Besides that, internal hemorrhoids have stages whereas its external equivalent does not. In the medical field, four stages are agreed to be present.

  1. First stage= There is no prolapse that can be observed by the individual affected but proctoscopy (a procedure to see the interior part of the anus by a device) reveals prominent blood vessels.
  2. Second stage= Upon straining, prolapse will occur but the goes back in spontaneously.
  3. Third stage= Prolapse is seen during bearing down but can be pushed back by using fingers.
  4. Fourth stage= The lump bulging out cannot be reduced at all.

All of these differences between them do not mean that similarities are absent. They do share the same risk factors:

  1. The tendency of the family in developing piles.
  2. Chronic diarrhea or constipation.
  3. An occupation that demands heavy-lifting activities such as labors and general workers.
  4. Obesity
  5. History of surgery at the rectum or any condition that causes weakening of anal tone.
  6. Colon cancer.
  7. History of multiple episiotomies.
  8. Anal intercourse.
  9. Decent socioeconomic status.
  10. Lacking in maintaining an erected posture.

Most of the hemorrhoids, regardless of the types, possess a good recovery prospect. They can resolve by their own or by using simple measures. Instilling a diet with high fibre and ensuring enough hydration are usually the first-liner to determine whether next step in the ladder of approach should be commenced or not. If it does not help then the attending surgeon can consider opting for band ligation, sclerotherapy or laser application. A much radical intervention, which is surgery can only be chosen should the conservative and non-invasive procedure is not fruitful.

It is worth to be noted that even after the issues have been settled, there is still a small window for it to reappears. So, the patients are encouraged to continue the diet with a high amount of fibre, besides trying to lose weight and avoiding themselves from sitting continuously for a long period of time. Read buasir answers by DoctorOnCall for more information about this problem in Malay.

About Jasper Barbour

Jasper Barbour

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