People use this term to mean lots of different problems in the anal region. Haemorrhoids are a little bit like varicose veins just inside the anus, and are completely different to perianal thrombosis, fissures, fistulas and skin tags.
Normally, there are small cushions of blood-filled tissue just inside the anus, but in some people they can become swollen, and over time may stretch the lining of the anus causing a permanent change in shape. Haemorrhoids are often painless, but they can bleed when they are swollen or after a firm stool, or one that was difficult to pass. The bleeding is not usually more than just a few millilitres per day, and is not enough to cause anaemia or serious risks to your health. Usually, the bleeding stops by the time you have finished your toilet routine.
Sometimes the blood inside them can clot, which is painful. This can even cause the haemorrhoid to poke outside the anus, where you might be able to feel it when you wipe clean. It may not easily pop back inside, and then it can become very painful. If this has happened, it is worth a trip to Emergency or to a trusted doctor for urgent relief – which will involve an operation.
If they become very swollen, they can pop outside the anus. Most people are quite keen to have them treated once they reach this stage.
Complicated haemorrhoids like this need formal removal, usually under a General Anaesthetic. The cushions are cut away, and their feeding blood vessels are tied off. Some surgeons believe that using a stapler device gives good results, too. The operation may require a few days in hospital to recover, and it is important to keep your stools soft and regular for comfort as the wounds heal.
Smaller haemorrhoids can be dealt with more gently – by injecting them with phenol or by placing tiny elastic bands around them. Both of these methods cause the vessels to scar up, and cause the haemorrhoids to shrivel away over a few days. As long as the treatment is applied high (or deep) enough, it only causes mild discomfort, and is usually performed in the doctor’s office without anaesthetic. There may be a lower abdominal “dragging” sensation which is usually well controlled with paracetamol.
When people talk of External Haemorrhoids, they are often referring to perianal thrombosis, which is just a fancy term for a tense bruise at the edge of the anus. Because it comes from the skin outside, you will not be able to push it back, and it is usually quite painful. After it settles down, the skin which was stretched over the bruise may stay stretched, and this results in a skin tag.
Other possible causes of pain in this region include fissures and fistulas.