Internal hemorrhoids are swollen veins located within the rectum, above the dentate line. Unlike external hemorrhoids, these internal swellings often do not trigger immediate pain or obvious symptoms. Sensations can vary, from complete absence to pronounced discomfort, depending on their size and any complications.
The Typical Absence of Sensation
Internal hemorrhoids frequently go unnoticed because the upper anal canal and rectum, where they form, contain few pain-sensing nerve endings. An uncomplicated internal hemorrhoid generally does not cause direct pain or a distinct feeling of its presence. Many individuals may be unaware they have them until a complication occurs.
The most common indicator of an internal hemorrhoid is bright red blood, typically observed on toilet paper after a bowel movement or sometimes in the toilet bowl. This bleeding is a visual sign, not a physical sensation, often occurring without pain. The blood results from fragile, distended blood vessels easily rupturing during defecation.
While direct pain is uncommon, some individuals might experience subtle sensations during or immediately after a bowel movement. These can include a feeling of pressure or a sense of incomplete evacuation. This sensation is often due to the bulk of the hemorrhoid partially obstructing the anal canal or creating a false sense of fullness.
Additionally, itching or irritation around the anus can sometimes be a secondary effect. This occurs when mucus discharge from the rectum or small amounts of stool can leak past the hemorrhoid, irritating the sensitive skin surrounding the anal opening. This external irritation can lead to a persistent itching sensation.
When Internal Hemorrhoids Cause Distinct Sensations
While typically asymptomatic, internal hemorrhoids can produce noticeable sensations when they undergo changes or complications. One common scenario is prolapse, where the internal hemorrhoid protrudes outside the anal opening during or after a bowel movement. A prolapsed hemorrhoid can feel like a soft, moist lump or bulge that may be manually pushed back inside.
This protruding tissue can cause discomfort, particularly when sitting, walking, or during physical activity. The sensation might be described as a dull ache, pressure, or a feeling of something “being there.” If the prolapsed tissue becomes irritated by friction from clothing or prolonged exposure, it can swell and become more tender, leading to increased discomfort.
A more intense sensation arises if a prolapsed internal hemorrhoid develops a blood clot, a condition known as thrombosis. The lump becomes much harder, significantly more painful, and tender to the touch. This pain is typically sudden in onset, sharp, and can be quite severe, making sitting or any anal pressure very uncomfortable.
In rarer instances, a prolapsed hemorrhoid can become strangulated if the anal sphincter muscles clamp down tightly around it, cutting off its blood supply. This condition leads to extremely severe and continuous pain, as the tissue begins to swell and can become ischemic. The sensation is one of intense, throbbing pain, often accompanied by significant swelling and discoloration of the prolapsed tissue.
When to Seek Medical Attention
Consult a healthcare professional if you experience any rectal bleeding, regardless of its perceived severity. While often due to benign conditions like hemorrhoids, rectal bleeding can also signal more serious underlying issues that require medical evaluation. A doctor can diagnose the cause and recommend appropriate steps.
Seek medical attention if you experience severe pain or discomfort in the anal region, especially if it appears suddenly, worsens rapidly, or interferes with daily activities. This includes a lump or swelling that does not resolve or becomes increasingly painful. Such symptoms could indicate a complicated hemorrhoid or another condition requiring intervention.
Changes in bowel habits, such as persistent constipation or diarrhea, or unexplained weight loss accompanying anal symptoms, warrant a medical consultation. These broader symptoms could suggest conditions beyond simple hemorrhoids. If self-treatment with over-the-counter remedies does not alleviate symptoms after a reasonable period, professional medical advice is necessary to explore other treatment options.