Bright red bleeding
If one or more of the swollen veins becomes "scratched" by hard stool, it may cause bright red bleeding. Often this is painless bleeding and comes out in the toilet bowl water or on toilet paper.
Most bright red rectal bleeding is due to hemorrhoids but there is always concern that a rectal cancer could be present so a rectal exam by a physician needs to be performed if there is bleeding.
Two sets of anorectal veins can become dilated. Internal and external hemorrhoidal veins. The external veins are just inside the anal sphincter while the internal veins are slightly higher up in the rectum.
If a large internal rectal vein prolapses and falls through the anal sphincter muscle, the vein becomes even more distended and then very painful. Most of the pain of hemorrhoids is due to prolapsed internal hemorrhoid veins or external veins that are swollen.
How can I treat the itching and pain of hemorrhoids?
Anal itching occurs because the surrounding skin tissue is traumatized due to excessive use of harsh toilet paper, a secondary irritant or allergic dermatitis due to soaps and creams used around the anus, and/or secondary yeast or parasite infections of the surrounding anal skin.
The best treatment for this is avoidance of any substance touching the perianal skin other than water from a shower or bath. Soap does not need to be used to wash bacteria away; water is sufficient.
An exception to this rule is that perhaps a non scented petrolatum gel or hemorrhoidal cream can be applied to the skin around the anus to protect from irritation. This is especially important if chronic diarrhea or loose stools result in greater soiling of the anal skin.
Almost always, a painful hemorrhoid is one that has prolapsed out of the anus.
The treatment is:
- prevent the prolapse of the hemorrhoid
- replace the prolapsed hemorrhoid inside the anus
Preventing the prolapse of a hemorrhoid is aided by avoiding any constipation and also lubricating the stool. Glycerin rectal suppositories can provide lubrication that prevents hemorrhoid friction and irritation (1).
Agar agar, a sea plant, can be used as a nutritional supplement both as a bulking agent as well as lubricating the stool. Cod liver oil, Senekot S ® and flaxseed are other supplements that can help provide a lubricated stool.