Hemorrhoids may present with symptoms typical of most anal conditions, including bleeding, pain, discharge, or a mass. Internal hemorrhoids bleed and prolapse to give a mass effect, and patients will notice that hemorrhoids may protrude with bowel movements. Irreducible prolapsed hemorrhoidal tissue External hemorrhoids generally do not bleed, but can thrombose and cause acute pain. Although external hemorrhoids can become necrotic and drain, most thrombosed hemorrhoids resolve spontaneously. Acute complications can occur with either prolapse of internal hemorrhoids or thrombosis of the external hemorrhoids.
Acute pain is usually constant and related to a visible mass.
Pain occurring after a bowel movement is rarely due to a hemorrhoid complication, but is more likely due to a fissure or ulcerating anal mass. Chronic anal pain and pruritus are generally not symptoms of hemorrhoids, but rather other diseases including anal fissure, mucosal prolapse, anal mass, or anal fistula which may be associated with excessive moisture leading to pruritus. These symptoms are nonspecific, and the presence of hemorrhoids should not be presumed since more severe conditions such as inflammatory bowel disease and cancer can mimic hemorrhoidal symptoms. Patients with severe pain or incarcerated protrusions should be seen promptly. Diagnosis is established with direct visualization by anoscopy or proctoscopy.