Three Types of Hemorrhoids: Internal, External, and Mixed Hemorrhoids Explained

Three Types of Hemorrhoids: Internal, External, and Mixed Hemorrhoids ExplainedHello everyone, today Liuqutang TCM Clinic will provide a detailed explanation of internal, external, and mixed hemorrhoids, helping patients better understand these three common anorectal diseases. Hemorrhoids are not a single disease, but rather are classified into three main types based on their location: internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids

Three Types of Hemorrhoids: Internal, External, and Mixed Hemorrhoids Explained

Hello everyone, today Liuqutang TCM Clinic will provide a detailed explanation of internal, external, and mixed hemorrhoids, helping patients better understand these three common anorectal diseases. Hemorrhoids are not a single disease, but rather are classified into three main types based on their location: internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids.

I. Anatomical Basis and Etiology of Hemorrhoids

To understand the three types of hemorrhoids, we must first understand the anatomy of the anus. Within the anus lies an important dividing line the dentate line. This line acts as a boundary, separating the anal region into two parts. The area above the dentate line is where internal hemorrhoids develop, while the area below is where external hemorrhoids develop.

So, what exactly are hemorrhoids? Simply put, hemorrhoids are diseases caused by the varicose dilation of venous plexuses in the anal area. Two main venous plexuses exist in the anal region: the superior rectal venous plexus and the inferior rectal venous plexus. The superior rectal venous plexus is located above the dentate line, while the inferior rectal venous plexus is located below it. When these venous plexuses become varicose, hemorrhoids form. Varicose veins above the dentate line form internal hemorrhoids; those below form external hemorrhoids.

It's worth mentioning that anal cushions also play a significant role in hemorrhoid formation. Located above the dentate line, anal cushions are rich in the superior rectal venous plexus and connective tissue. Their soft tissue structure is crucial for maintaining normal anal function, helping to close the anus and prevent fecal leakage during defecation. When the veins within the anal cushions become varicose, or when the cushions themselves become displaced, internal hemorrhoids are likely to form.

II. Clinical Manifestations and Staging of Internal Hemorrhoids

The typical symptom of internal hemorrhoids is painless rectal bleeding, sometimes accompanied by prolapse of hemorrhoidal tissue. This is because the varicose venous plexuses, like small balloons, are easily irritated and ruptured by passing stool, resulting in blood on the stool or bleeding after defecation. As the condition progresses, the enlarged hemorrhoidal tissue may prolapse outside the anus during defecation, making the hemorrhoid mass visible.

Based on the degree of prolapse, internal hemorrhoids are classified into four stages:

• Stage I: No prolapse; only bleeding is present.

• Stage II: Prolapse during defecation, spontaneously reduces afterward.

• Stage III: Prolapse during defecation, requires manual reduction.

• Stage IV: Prolapse that cannot be reduced spontaneously, and may even become strangulated outside the anus.

III. Clinical Manifestations and Types of External Hemorrhoids

External hemorrhoids occur below the dentate line. Since this area is richly innervated with sensory nerves, patients with external hemorrhoids usually experience noticeable local symptoms such as anal discomfort, itching, or a foreign body sensation.

If a thrombus forms in the inferior rectal venous plexus, or a hematoma develops under the anal skin, causing the hemorrhoid mass to significantly enlarge, it can compress the anal skin, causing severe pain. This type of hemorrhoid is called a "thrombosed external hemorrhoid."

The clinical manifestations of external hemorrhoids mainly include: anal swelling, anal discomfort, itching, or a foreign body sensation. Severe pain accompanies thrombosed external hemorrhoids.

IV. Clinical Manifestations and Formation Mechanism of Mixed Hemorrhoids

Mixed hemorrhoids are the simultaneous presence of internal and external hemorrhoids, exhibiting symptoms of both. Internal hemorrhoids are usually located above the dentate line, but when they progress to stage III or IV, due to the existence of communicating veins, they may connect with external hemorrhoids, forming mixed hemorrhoids. It is important to note that only when the internal and external hemorrhoids are truly connected can it be classified as a mixed hemorrhoid. The mere co-existence of internal and external hemorrhoids does not constitute a mixed hemorrhoid.

As the condition progresses, the hemorrhoidal mass of mixed hemorrhoids will gradually enlarge and may prolapse outside the anus, forming a shape resembling a blooming plum blossom, known as a "circumferential hemorrhoid." If the prolapsed hemorrhoidal mass becomes trapped by the anal sphincter and cannot be reduced, it is called an "incarcerated hemorrhoid," a serious complication requiring prompt medical attention.

V. Traditional Chinese Medicine (TCM) Treatment of Hemorrhoids

TCM treatment of hemorrhoids emphasizes syndrome differentiation and individualized treatment based on the patient's clinical symptoms and signs. Common syndromes include downward flow of intestinal wind, downward flow of damp-heat, qi and blood stagnation, spleen deficiency and prolapse, liver stagnation and blood heat, mixed cold and heat, and cold-damp obstruction.

TCM treatment methods for hemorrhoids primarily involve internal and external therapies. Internal therapy involves taking herbal medicines to regulate organ function, achieving the effects of clearing heat, cooling blood, and removing wind; clearing heat and promoting urination to stop bleeding; removing blood stasis, reducing swelling, and detoxifying; tonifying qi and lifting prolapse to stop bleeding; softening the liver and cooling the blood; balancing cold and heat; and warming yang, dispersing cold, and reducing swelling. Clinically, it has been found that for patients with accurate syndrome differentiation, taking herbal medicine can effectively improve symptoms such as bleeding, pain, and burning sensation, with significant efficacy.

In addition to internal therapy, TCM also offers several external treatment methods that can assist in treating hemorrhoids. However, regardless of the treatment method used, it should be done under the guidance of a professional doctor.

VI. Conclusion

In summary, hemorrhoids are common anorectal diseases with complex types and diverse symptoms. Early detection and treatment, along with choosing the appropriate treatment method, are crucial for alleviating symptoms and improving quality of life. Liuqutang TCM Clinic reminds patients not to be complacent, to avoid delaying treatment and increasing the difficulty of treatment. If you experience any discomfort, please seek medical diagnosis and treatment promptly.

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