Clinical Features

Home/About Hemorrhoids/Clinical Features

Clinical Features

Internal piles: Internal hemorrhoids which also include the interoexternal piles (hemorrhoids) are very common.


Symptoms usually include:

  • Bleeding (bright red) is the earliest symptom. Earlier the bleeding is slight and bright red in color and occurs with passage of stool. Piles (hemorrhoids) that bleed but do not bulge out (prolapse) outside the anal canal are called first degree piles (hemorrhoids).
  • Prolapse (bulge out) of piles (hemorrhoids) is usually a later symptom. In the beginning the piles (hemorrhoids) may prolapse during the passage of stool but they recede (draw back) through the anal opening on their own. These are called second degree piles (hemorrhoids).
  • As the condition further progresses the piles (hemorrhoids) do not recede back and have to be replaced by hand. These piles (hemorrhoids) are called third degree piles (hemorrhoids).
  • In more advanced stages the piles (hemorrhoids) may bulge out anytime during the day, even without defecation (passing stool) especially when person is either tired or exerts himself. These piles (hemorrhoids) which are permanently prolapsed are called fourth degree piles (hemorrhoids). It results in a feeling of discomfort and heaviness in the rectum.
  • A mucoid (slimy) discharge usually accompanies prolapsed piles (hemorrhoids).
  • Itching in and around the anus.
  • Pain may or may not be present.
  • Anemia is usually caused especially in long standing cases due to profuse bleeding from piles (hemorrhoids).

External piles (hemorrhoids): External piles appear suddenly due to straining while passing the stools, constant coughing, or lifting heavy weights which causes the blood to collect in the veins around the anal region which therefore swell up.

They may present as: