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Two types of nerves are found in the anal canal; those upon the dentate line are called the visceral nerves and those under the dentate line are called the somatic nerves. Like the skin nerves of our body, the somatic nerves are capable of sensing pain and like our intestine nerves, the visceral nerves can only feel the pressure and not the pain. That is why the internal hemorrhoids are usually painless, since they are upon the dentate line.
In the internal hemorrhoid, the anal cushion starts enlarging and the swelled cushion enters the anal canal. Sometimes, it can affect the rectum by pulling down its lining, losing the normal anchoring and extending out of the anus. This is called a Prolapsing Internal Hemorrhoid. In this type of hemorrhoid, the patient has to face troubles while passing stools, particularly if he or she is having constipation and has to pass a hard stool. Passing the stool can be very painful and it may also bleed.
The pulled down rectum lining starts secreting mucus and the anus and its surrounding skin become moist. Presence of stool can affect the anal skin and with constant moisture it can cause skin itching, which is not a common symptom of hemorrhoids. The extended hemorrhoid can be pushed back into the anus with a finger but it again will come out when the next stool is passed.
Incarceration of the Hemorrhoid is a condition where one cannot push back the hemorrhoid back into the anus. Blood supply is stopped by the squeezed anal sphincter pressure and the cushions and blood vessels die. This condition is called gangrene and it requires proper treatment.
Physicians have given grades to different internal hemorrhoids in order to make it easier to determine their severity:
Hemorrhoid of the first degree: Hemorrhoid that bleeds and does not prolapse.
Hemorrhoid of the second degree: Hemorrhoid that prolapses and retracts on its own. It may or may not bleed.
Hemorrhoid of the third degree: Hemorrhoid which prolapses but has to be pushed back by finger.
Hemorrhoid of the fourth degree: Hemorrhoid which prolapses and cannot be pushed in.
Some of the hemorrhoids of the fourth degree contain blood clots and affect the rectum lining by pulling it through the anus.
External hemorrhoids have different symptoms than those of internal hemorrhoids. These hemorrhoids grow at the lower part of the anal canal and the anus function does not get affected much. The blood clots in the external hemorrhoids can become a problem and especially painful when they grow into lumps, a condition referred to as thrombosis.
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