Bleeding Hemorrhoids

Internal hemorrhoids occur above the pectinate or dentate line in the anal canal. They are covered by a mucous membrane.

The internal hemorrhoid is graded to assist with the selection of a treatment plan. The treatment is then provided according to the grade. The grade of the hemorrhoid depends on the extent of descent into the anal canal and out of the anus.

The grade of the hemorrhoid depends on the extent of descent into the anal canal and out of the anus.

• First degree- Here the internal hemorrhoids are enlarged, but they never prolapse and rarely produce symptomatology. This cannot be visualized during an external examination but require the use of a proctoscope.
• Second degree- Here the internal hemorrhoids prolapse with defecation but they return to their original position spontaneously. Like the first degree this also cannot be visualized during an external examination but require the use of a proctoscope.
• Third degree- Unlike the first two internal hemorrhoids prolapse with each bowel movement and even with physical exertion. Some hemorrhoids require manual replacement back to their point of origin.
• Fourth degree- They are permanently prolapsed despite attempts to place them to their original position.

All four risk for thrombosis, severe pain and bleeding.

The most common sign of internal hemorrhoids is rectal bleeding. Hemorrhoids can ooze fresh red blood, whether located externally or internally. But bleeding internal hemorrhoids may produce fresh blood in the stool.