Haemorrhoids can become swollen, painful and inflamed (‘flare up’) and bleed when irritated. They may be itchy or associated with a mucous discharge. At other times, when they are not swollen or irritated, they may cause no symptoms.
Internal haemorrhoids come from veins inside the rectum and usually can’t be seen from the outside. However, they can cause a feeling of pressure in the rectum and can bleed, especially when you pass a stool. You might notice streaks of bright blood on the outside of a stool or on the toilet paper when you wipe your bottom, or splashes of blood in the toilet bowl.
Internal haemorrhoids can cause mucus to leak from the rectum onto the anal skin. This moisture encourages secondary skin infections, and results in the itchiness that often accompanies haemorrhoids.
Internal haemorrhoids are not usually painful, but if one becomes very large, it can hang out of the anus (called a ‘prolapsed haemorrhoid’), causing pain and increased swelling.
External haemorrhoids come from veins outside of the anus. They look like one or more firm grape-like swellings on the outside of the anus. External haemorrhoids can become painful and irritated, and can bleed or itch. Blood pooling in an external haemorrhoid can lead to a blood clot forming in the haemorrhoid. This results in a firm, bluish swelling on the edge of the anus that is very painful. This pain usually intensifies over about 3 days then settles as the clot resolves.
When a swollen haemorrhoid subsides, the area of anal skin that overlies it can hang a bit loose, because it was stretched when the haemorrhoid was swollen. This small area of loose skin is called a ‘skin tag’. Several skin tags can give the anus a ruffled rather than a smooth appearance. Skin tags do not usually cause discomfort but they can make cleaning your bottom after passing a motion more difficult. It is best to wash the area or use a moist disposable wipe, rather than dry toilet paper.