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:: Hemorrhoidal Disease - Symptoms

Hemorrhoid disease


Symptoms vary with conditions such as pregnancy, repeated straining, constipation, diarrhea, changes in diet or work pattern.
They may undergo periods of remission and relapse.


The most common symptom is bleeding after going to the toilet. Hemorrhoid bleeding is bright red and usually noticed in wiping or in the toilet bowl.

According to a recent review of the literature, the incidence of ano-rectal bleeding in the general population is approximately: 20%/year.It is estimated

Most frequent causes of anal bleding ( Nicholls 1985)

Perianal lesion 7%
Anal Fissure 18%
Hemorrhoids 54%
Tumoral lesion 6,5%
Inflammatory disease 5%
Alterations of intestinal transit 3,5%
Other 3%
Not identified 3%


Internal hemorrhoids are usually painless. An intense pain is usually associated to anal fissure, ano-rectal abscess, etc.
Possible complication of hemorrhoids that hang down (grade 3 and 4) is thrombosis which can form within the hemorrhoid. This is not so common, but causes intense pain if it occurs

Causes of pain identified during a proctologic examination (: Godeberge 1993)

  • Hemorrhoidal thrombosis
  • Fissure
  • Abscess and fistula
  • Tumors
  • Peri-anal Crohn's disease
  • Proctalgia fugax
  • Faecaloma
  • Papillitis
  • Peri-anal glands infection


Prolapse occurs with bowel movement and is associated with an uncomfortable sensation of fullness and incomplete evacuation. Larger hemorrhoids may cause a mucus discharge, some pain, irritation, and itch.
The discharge may irritate the skin around the anus. You may have a sense of fullness in the anus, or a feeling of not fully emptying your bowel when you go to the toilet.

Fourth degree hemorrhoids may become “strangulated” and present with acute, severe pain.

Generally, the therapeutical choice depends on the entity of the hemorrhoid prolapse, therefore the most used classification of hemorrhoids (Goligher ), is the grading of the hemorrhoid prolapse.