From a patient’s perspective, any anal-related complaint will likely be called “hemorrhoid” when, in reality, there may be another condition. It is essential to understand some points and clarify what hemorrhoids are and are not.
The hemorrhoidal disease, popularly known as “hemorrhoids,” refers to tiny anal piles within the anal canal when they become permanently enlarged and frequently swollen, causing symptoms.
The medical term “hemorrhoids” refer to the last portions of the rectal veins, arteries that provide the blood supply to that region, and the structures that hold them all in place, collectively called “anal piles.”
These piles are structures located inside the anal canal and are not visible to the outside unless they become sick. They look like slightly purple, well-organized lumps. These piles also have even smaller counterparts with similar structures on the outside of the anal canal, underneath the anal skin, and they are not noticeable in a visual inspection of a healthy anus either.
There are three main anal piles containing hemorrhoidal vessels cushioned by soft tissue and delicate muscles held in place by fragile, elastic structures around the anal canal. During a normal bowel movement (defecation), these little piles retain more blood (ingurgitate) and become temporarily enlarged as they move downwards, escorting the stools.
Thanks to the fragile but efficient elastic structures holding the anal piles in place, they come back quickly once the stools pass. This natural, effortless, and painless process allows the hemorrhoids to protect the anal canal from damage during defecation, besides other functions we will address in other posts.
When structures within an internal anal pile become dysfunctional, internal hemorrhoidal disease may occur (or “internal hemorrhoids”). Likewise, external hemorrhoidal disease may occur if it happens to the outer counterpart (or “external hemorrhoids”). It is also possible for internal and external anal piles present with problems simultaneously, which would be called mixed hemorrhoidal disease.
