Hemorrhoids are a common condition involving swollen veins in the rectum or anus, similar to varicose veins found elsewhere in the body. They develop internally (within the rectum) or externally (beneath the skin around the anal opening). The location and severity of these swollen veins lead to a range of physical sensations and discomforts.
Chronic Daily Discomfort and Irritation
The persistent, day-to-day experience of hemorrhoids often centers on irritation and a feeling of general fullness in the anal region. This chronic discomfort is frequently described as intense anal itching, known medically as pruritus ani, which can sometimes worsen at night. Swelling or slight protrusion creates folds that make cleaning difficult, leading to trapped moisture and residues that irritate the sensitive perianal skin. This irritation often evolves into a burning sensation, especially after wiping or when sitting for extended periods.
Many individuals experience a sensation of anal pressure or fullness, feeling as though something is constantly present. This feeling of incomplete evacuation, or tenesmus, occurs because the swollen internal tissue creates a sense of obstruction, even when the rectum is empty. External hemorrhoids, located where nerve endings are abundant, can be felt as small, rubbery lumps just outside the anal opening. The presence of this protrusion can cause a noticeable, low-grade discomfort throughout the day.
Sensations During Bowel Movements
The act of elimination can dramatically change the sensory experience of hemorrhoids, transforming chronic discomfort into acute, transient pain. Straining to pass a hard stool increases pressure on the swollen veins, causing a sharp, tearing sensation as the stool passes. This pain is particularly noticeable with external or prolapsed internal hemorrhoids, which are rubbed and compressed by the moving fecal matter. Discomfort often lingers immediately afterward, manifesting as a dull ache or throbbing sensation that slowly subsides.
Straining is the primary trigger for the most common visible symptom: painless bleeding from internal hemorrhoids. This non-painful sensation involves noticing bright red blood on the toilet paper, in the toilet bowl, or streaked on the surface of the stool. Bleeding occurs when the fragile, engorged veins of the internal hemorrhoid are scraped or irritated by the passage of stool. In some cases, especially with prolapsed internal hemorrhoids, a thin discharge of mucus may be observed, which further contributes to perianal irritation and itching.
When the Feeling Becomes Acute (Thrombosis)
A distinct and significantly more intense experience occurs when a blood clot forms within an external hemorrhoid, a condition known as thrombosis. This complication causes the rapid onset of severe, unremitting pain, dramatically different from manageable daily discomfort. The vein’s quick distention by the trapped clot causes stretching of the highly sensitive surrounding skin, leading to a throbbing sensation. The pain can be so intense that sitting, walking, or even coughing becomes difficult.
Upon touching the affected area, the thrombosed hemorrhoid feels like a firm, taut lump that is tender to the slightest pressure. Unlike the softer texture of a typical external hemorrhoid, this clot-filled mass is hard and often appears dark blue or purple due to the trapped blood. This acute, constant pain typically peaks within the first 48 hours and then slowly begins to resolve as the body reabsorbs the clot. The tenderness and sudden swelling clearly distinguish a thrombosed hemorrhoid as the most painful manifestation of the condition.