Different Types of Piles

Internal Haemorrhoids

Internal haemorrhoids are swollen veins that develop deep within the rectum. Due to their location, they are not visible or palpable, and rarely cause noticeable symptoms due to the fact that there are no pain nerves in the rectum. Internal haemorrhoids are mostly harmless and go away on their own.

However, larger ones can cause symptoms such as pain, itching or a burning sensation. A lump may also be felt near the anus. There may be rectal bleeding as well during bowel movements. Sometimes, passing stool or overstraining while passing stool can push the internal haemorrhoid, causing it to protrude out the anal opening (prolapsed haemorrhoid).

Prolapsed Haemorrhoids

Internal haemorrhoids that protrude or have been pushed out of the anus are called prolapsed haemorrhoids. Prolapsed haemorrhoids can be graded according to the extent of the protrusion:

• Grade I – Internal haemorrhoids with no prolapse.
• Grade II – Prolapse occurs when there is increased pressure in the rectal or anal area, such as straining when passing stool. However, the haemorrhoid retracts into the rectum on its own after a bowel movement.
• Grade III – Similar to Grade II, haemorrhoids stick out of the anus during bowel movements, but in this case, they don’t retract back on their own afterwards. Instead, they will need to be pushed back in.
• Grade IV – The prolapsed haemorrhoids protrude out of the anus and cannot be pushed back into their normal positions. At this stage, the haemorrhoids run the risk of becoming strangulated, a serious and emergency condition where blood supply to the haemorrhoid has been cut off due to pressure, resulting in intense and sudden pain.

The main symptom of a prolapsed haemorrhoid is the visible and protruding haemorrhoid itself. They are sometimes accompanied by pain, burning and itching. Depending on the grade, a prolapsed haemorrhoid can be treated through diet and lifestyle modifications, rubber band ligation, sclerotherapy or piles surgery.

External Haemorrhoids

External haemorrhoids are usually the first thing people think of when they hear the word haemorrhoids. These are visible and palpable lumps that form on the skin around the anus. They are similar to internal haemorrhoids in terms of symptoms, except that internal haemorrhoids are located inside the rectum.

However, because external haemorrhoids are formed outside of the body, symptoms like pain are more severe, and for some people, the symptoms can disrupt daily activities such as sitting, doing physical activities or during bowel movements.

Thrombosed Haemorrhoids

A thrombosed haemorrhoid is an internal or external haemorrhoid in which a blood clot, called thrombus, is formed. Being a serious complication of an untreated haemorrhoid, a thrombosed haemorrhoid causes more severe symptoms, including intense pain, burning, itching, redness and swelling.

While not a life-threatening condition, thrombosed haemorrhoids require immediate medical attention. Its main treatment is a surgical procedure known as a thrombectomy, where the blood clot within the haemorrhoid is cut and drained. A thrombectomy is different from a haemorrhoidectomy or piles surgery, which is surgery to remove the haemorrhoid.