Patients visit my proctology clinic, complaining of symptoms such as bleeding, pain, discomfort, and itching in the perianal region. In most cases, such symptoms are indicative of such conditions as "hemorrhoids (piles)," "anal fissure," or "anal fistula." However, they may be symptomatic of any of the following diseases other than hemorrhoids: perianal dermatitis in patients with perianal discomfort or itching, and pudendal neuralgia in patients with pain. This is an example of a case where a patient who had undergone surgery for internal hemorrhoids visited my clinic, complaining of persistent postoperative pain. Since the patient also had pudendal neuralgia, the patient’s condition was aggravated by comorbid genital neuralgia and postoperative pain. It is important to properly identify the cause of pain or discomfort after careful consideration as to whether the cause is hemorrhoids and to provide appropriate treatment, not simply judging it as hemorrhoids.
When hemorrhoids (piles) or anal prolapses become large, swelling of the affected area may cause a sensation of inadequate defecation even after stools have been evacuated from the rectum. Patients with such symptoms may use OTC drugs while checking for the effectiveness of such drugs. Hemorrhoid swelling is a circulatory disorder due to poor blood circulation. If drug therapy improves blood circulation, swelling may subside, and mild anal prolapse or a sensation of inadequate defecation may be resolved.
Anal fissure is not noticeable at first. OTC drugs are effective against minor anal bleeding. However, such a patient may have a bowel movement before the wound is healed, and anal fissure may repeatedly occur, resulting in chronic anal fissure. Therefore, caution must be exercised.
There are various types of “hemorrhoids,” but the most common type is “hemorrhoids” known as “piles.” Other types include "anal fissure" and "anal fistula." Symptoms differ according to the types. Symptoms of "hemorrhoids (piles)" include bright red anal bleeding and prolapsed hemorrhoids. Symptoms of “anal fissure” include minor bleeding and pain. Symptoms of "anal fistula" include a mass or itching, and pain or pyrexia if it becomes purulent. Some patients visit our hospital due to "anal pruritus" in which itching occurs around the anus, or "rectal prolapse" in which the rectum protrudes out the anus.
Typical symptoms are anal bleeding, prolapse, and pain. Difficult defecation, dyschezia, may also occur. This is related to pain, and especially patients with anal fissure cannot pass stools due to pain. Repeated recurrences of anal fissure often cause anal stenosis, a gradual narrowing of the anus. The condition worsens with every bowel movement and may result in the necessity for surgery. There are many patients complaining of anal or perianal discomfort, which includes such symptoms as "anorectal tingling after defecation" and "feeling something swollen." These are thought to be signs of worsening hemorrhoids due to temporary damage to the anal canal. Such symptoms are temporarily alleviated, but generally worsen overall while repeatedly alternating remission and worsening. It is important for patients to visit a hospital soon after any abnormal feeling is noted.
External hemorrhoids (piles formed outside the anus) may cause prolapse as well as symptoms of pain, bleeding, swelling, and pruritus (itching). On the other hand, internal hemorrhoids (piles formed inside the anus) are mainly associated with bleeding or prolapse, causing pain in rare cases. However, severe pain may occur if internal hemorrhoids are accompanied by anal fissure or external thrombosed hemorrhoids (blood clots). Pain caused by external hemorrhoids is often mild and is usually dull pain. Only external thrombosed hemorrhoids cause severe pain. Acute anal fissure pain occurs and persists during defecation. However, in most cases, it resolves spontaneously in 4 to 7 days even if left untreated, and the pain disappears. If painful defecation persists for three weeks or pain persists for several hours after defecation, it is recommended to visit a hospital or clinic because anal fissure may have become deep or chronic.
