The signs and symptoms of hemorrhoids are many and varied, the most common being extreme pain in the recto-anal region, appearance of sensitive lumps or swelling near the anus, leaking stool, excessive rectal bleeding, bloody toilet paper or blood in the toilet bowl after a bowel movement, feelings of dizziness or faintness, itching and burning sensations, and general irritation or discomfort. It is estimated that 50 to 75 percent of Americans will experience at least one of these hemorrhoid symptoms by the age of 50. Due to the potential dangers and complications associated with hemorrhoids, the earlier that these signs are caught and addressed, the better.
Hemorrhoid signs and symptoms typically depend on their location, whether internal or external. The most common symptom of internal hemorrhoids is rectal bleeding, which may result in red streaks of blood on toilet paper while wiping, bright red blood in the toilet bowl after a bowel movement, or visible blood on the surface of the stool that has been passed. This painless bleeding that occurs during a bowel movement is known as hematochezia. Similarly, external hemorrhoids are also known to cause rectal bleeding, but they are commonly associated with additional symptoms as well. The most common ones include discomfort and pain in the rectum, pooling of blood under the skin, and formation of hard, painful lumps. For this reason, external hemorrhoids are often far more bothersome.
If internal hemorrhoids become inflamed, they can cause swelling which can then lead to muscle spasms in the muscles surrounding the rectum and anus, thereby causing pain. When this occurs, the hemorrhoid may protrude or prolapse and create a palpable lump at the anal verge. Inflamed hemorrhoids can also leak mucus and cause inflammation of the skin surrounding the anus, leading to a burning sensation or intense itching, the latter of which is commonly referred to by its Latin name pruritus ani. Itching is a frequent complaint because seeping mucus naturally irritates the anal skin.
In the case of thrombosed hemorrhoids, there may be one or more sensitive lumps near the anus. These are not dangerous, but they can be extremely painful and may need to be lanced and drained. While both internal and external hemorrhoids can become thrombosed, it is far more common for the latter. Signs and symptoms of thrombosed hemorrhoids include a sudden onset of pain and constant pain following this sudden onset. Characteristics unique to thrombosed hemorrhoids are being blue or purple in color, being lumpy or bulgy, and feeling firm to the touch.
Given these signs and symptoms, hemorrhoids are most often diagnosed through a simple visual examination in which doctors look at the anus or rectum. This is especially useful when diagnosing external hemorrhoids and prolapsed internal hemorrhoids. In situations where the hemorrhoid is not easily seen, a digital rectal exam may be necessary. This is where the doctor inserts a finger covered by a lubricated glove into the anus or rectum to feel around for any abnormalities. If additional measures need to be taken, doctors may use an imaging scope to look inside the rectum. This is done by inserting a thin tube with a light in order to examine for internal hemorrhoids.
Resources:
1) https://www.healthline.com/health/types-of-hemorrhoids#diagnosis
2) https://www.medicinenet.com/hemorrhoids_piles/article.htm
3) https://ada.com/signs-of-hemorrhoids/