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HEMORRHOIDS: Unexpected Signs and SYMPTOMS by: Sue Bristol, R.N. Before I get into the unexpected problems, I must explain the essentials about hemorrhoids. There are basically two kinds of hemorrhoids: a) external which protrude out of the anus and are therefore visible b) internal which are located inside the rectum and are typically not visible without the use of a medical instrument. External hemorrhoids may be symptom free in themselves. However, because of creases and crevices associated with them, the area may be inadequately cleaned. This in turn may cause soreness and itching. However, a complication may arise, often after straining, lifting, or coughing, when a blood vessel ruptures and a clot develops. This event, called a thrombus or a thrombosed hemorrhoid, is characterized by a sudden onset of pain in the anal region and the appearance of the hemorrhoid becomes swollen and purple. Internal hemorrhoids typically do not cause pain because of the scarcity of "pain nerves" in the lower rectum. The primary symptom usually associated with internal hemorrhoids is the appearance of bright red blood, typically on the toilet paper, in the toilet water, or in the fecal matter. The blood is associated with injury to the covering of the vessels in the rectum, usually by hard stool. Internal hemorrhoids may also cause a discharge of mucous and a feeling that there is still stool in the bowel. Sometimes, however, the hemorrhoid may protrude out of the anus. This is called a "prolapse" and may cause pain because the muscles will often become painfully tight in the body's attempt to hold the hemorrhoid inside the rectum. Protruding, or prolapsed, hemorrhoids may also cause prolonged and severe itching in the anal region. This is a condition called pruritis ani and usually occurs because mucous and fecal matter collect on the skin around the anus. This often leads to "unexpected behavioral changes" which may result from hemorrhoids. These are the emotional conditions of depression and social anxiety associated with fears about discomfort, itching, or drainage. Unfortunately, because of the location of hemorrhoids people are often reluctant to discuss their condition with others because it all seems too private. This leads to a sense of embarrassment and shame and often causes people to isolate themselves and withdraw from usual social activities. Looking at this logically for a minute: what could possibly be embarrassing about a physical dis-order; especially when the remedies are so effective AND are totally under your control? Hemorrhoids are no laughing matter. There are numerous treatment and self-care options available, depending upon the severity of the condition. Please do not deprive yourself of the help that is out there because of embarrassment. There is NO need for any embarrassment, and your self-confidence will soar as soon as you take charge of your problem. Life is too short to waste any of it enduring often unnecessary misery.
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Sue Bristol, R.N.
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