[Medical Q&A] What are “internal hemorrhoids”, “external hemorrhoids” and “mixed hemorrhoids”?

Planner: Chinese Medical Association

Reviewer: Rong Long, Chief Physician, Peking University First Hospital

Hemorrhoids are venous masses caused by varicose veins at the lower end of the rectum. They are a common disease and are divided into internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids. There is a structure in the anus called the dentate line. Below the dentate line are peripheral nerves, which are very sensitive to pain and will feel obvious pain when stimulated; above the dentate line are mainly distributed autonomic nerves, which will not cause pain even if stimulated. Hemorrhoids that grow below the dentate line are called external hemorrhoids, which usually cause pain; those that grow above the dentate line are called internal hemorrhoids, which generally do not cause obvious pain; if the hemorrhoids cross the upper and lower parts of the dentate line at the same time, they are called mixed hemorrhoids or internal and external hemorrhoids.

The incidence of hemorrhoids is very high, and there is a saying among the people that "nine out of ten people have hemorrhoids." However, not all hemorrhoids will show symptoms. Only about 50% of patients will experience obvious discomfort, especially young and middle-aged people aged 20 to 40 are more likely to be affected. The early symptoms of hemorrhoids mainly include local anal itching, dampness and discomfort, and blood in the stool. If these symptoms occur, you should go to a specialist hospital in time for a clear diagnosis and appropriate treatment.

Different types of hemorrhoids require different treatments. For external hemorrhoids, there is currently no effective drug that can completely remove them, and surgical resection is the most commonly used treatment. For internal hemorrhoids, there are a variety of treatment options, including injection therapy, ligation therapy, stapler resection, electrochemical therapy, etc. In addition, endoscopic ligation and injection techniques have also been widely used in recent years with good results.

For mixed hemorrhoids, more complex treatments are often used clinically, such as band ligation or hemorrhoidal circumcision (PPH). These methods relieve symptoms by reducing the blood supply to hemorrhoids or repositioning the rectal mucosa. With the advancement of medical technology, the treatment of hemorrhoids has become safer and more efficient.