Haemorrhoids are classified as internal or external depending on where they are in relation to a line (the dentate line) that separates the two types of anal skin.
External haemorrhoids develop below the line and are generally painless. They rarely need medical treatment, unless a vein bursts, blood pools under the skin and a painful lump forms(this is called a clotted or thrombosed haemorrhoid).
Internal haemorrhoids develop above the dentate line. They can range in size from a slight swelling under the wall of the canal to large, sagging veins that stick out of the anus all the time. For treatment purposes, internal haemorrhoids are graded according to their size:
- GRADE 1: The vein bulges during bowel movements.
- GRADE 2: The vein comes out of the anus during bowel movements but goes back by itself.
- GRADE 3: The vein comes out during bowel movements but doesn't go back by itself. It must be replaced by hand.
- GRADE 4: The vein sticks out all the time and cannot be replaced.
It is possible for a person to have both internal and external haemorrhoids at the same time.
HOME AND MEDICATION TREATMENT OPTIONS
The best treatment is prevention, and such strategies are also effective when haemorrhoids have already developed.
In addition, most small internal haemorrhoids can be treated at home with the following techniques:
- Try not to sit for long periods. Take frequent breaks.
- A doughnut-shaped cushion can make sitting more comfortable and ease haemorrhoid pressure and pain.
- Insert petroleum jelly just inside the anus to make bowel movements less painful.
- Ointments that contain hydrocortisone may help decrease inflammation and speed healing.
- Resist the temptation to scratch haemorrhoids, as this irritates the inflamed veins more, damages the surrounding skin and intensifies the itchiness. Non-prescription haemorrhoid creams may help for the itching and pain.
- When wiping, be gentle. If toilet paper is irritating, try dampening it first, or use cotton balls or alcohol-free baby wipes. You may prefer washing yourself and then dabbing the area dry.
- Bathe regularly to keep the anal area clean but be gentle. Excessive scrubbing, especially with soap, can intensify burning and irritation.
External haemorrhoids usually do not need treatment, unless an enlarged vein near the anus bursts, forming a hard and extremely painful lump under the skin (thrombosed haemorrhoid). If the pain is not too severe, stool softeners, topical pain-relieving creams and Sitz baths (sitting in a bathtub of warm water for 15 minutes several times a day, especially after a bowel movement) may be sufficient. If pain is severe, surgical treatment may be required. If the lump is not removed within 24-48 hours, the pain will gradually lessen over the next 4-5 days. The skin covering the lump may break open on its own, causing mild bleeding. With good self-care, pain and bleeding stop within two weeks (although the lump may remain for several weeks).
Anaesthetising creams and suppositories to reduce inflammation may relieve irritation and pain due to internal haemorrhoids. Internal haemorrhoids that continue to bleed after a trial of home treatment or become so large that they stick out of the anus may require professional treatment.