What are internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids? How to distinguish?

It is said that nine out of ten men suffer from hemorrhoids, and it is not uncommon in women as well. Hemorrhoids are a common clinical disease. Let’s take a look at the classification of hemorrhoids and their respective characteristics today. Hemorrhoids are divided into three categories above and below the dentate line: internal hemorrhoids, external hemorrhoids and mixed hemorrhoids. So what are the differences between these three types of hemorrhoids?

1. Internal hemorrhoids

It occurs above the dentate line, with painless intermittent bleeding, bright red bleeding, dripping or spurting blood, and prolapse of hemorrhoids as the main symptom. Hemorrhoidal prolapse is divided into four stages:

Stage I: The patient has mainly painless blood in the stool, the blood is not mixed with the stool, there is no prolapse, and the bleeding stops on its own after defecation.

Stage II: There is dripping or spurting blood during bowel movements, and hemorrhoids may prolapse, but they may retract on their own after bowel movements.

Stage III: There is blood or dripping blood during bowel movements, and the bleeding has decreased. The hemorrhoids need external force to be retracted after prolapse. When the patient stands or squats for a long time, coughs, is tired, or carries heavy weight, the hemorrhoids will prolapse again.

Stage IV: Hemorrhoids prolapse for a long time and cannot be retracted, which may be accompanied by symptoms such as strangulation, incarceration, and pain.

2. External hemorrhoids

Occurs in the anal canal and anal margin below the dentate line. The surface of external hemorrhoids is covered with skin and can be seen or touched. Hemorrhoids cannot be inserted into the anus and are not easy to bleed. The main symptoms are pain, foreign body sensation, and anal swelling. Clinically, they are divided into four types:

① Inflammatory external hemorrhoids: often caused by anal skin damage and infection. The skin wrinkles around the anus are like blisters. The swelling and pain are obvious.

② Thrombosed external hemorrhoids: The anal venous plexus ruptures, blood leaks out of the blood vessels, and forms a thrombus that bulges under the skin. It is characterized by sudden onset, local swelling and severe pain.

③ Connective tissue external hemorrhoids: Due to chronic inflammatory stimulation, repeated inflammation and swelling, the skin folds around the anus become larger, the connective tissue proliferates, and skin tags of varying sizes are formed.

④ Varicose external hemorrhoids: subcutaneous varicose veins around the anal margin increase abdominal pressure when squatting and increase in size during defecation. Symptoms can be alleviated to varying degrees after returning to normal position.

3. Mixed hemorrhoids

Mixed hemorrhoids occur above and below the dental line in the same position as the anus. Painless intermittent bleeding after defecation, mainly in the form of dripping blood. In the middle stage, hemorrhoids may prolapse, followed by symptoms such as pain and heaviness. In the later stage, due to long-term prolapse of hemorrhoids and relaxation of the anal sphincter, secretions often appear. The secretions irritate the perianal area and cause anal itching or perianal eczema. Clinically, there are symptoms of both internal and external hemorrhoids.