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Hemorrhoids are classified into internal and external hemorrhoids. There is a
line (the dentate line) in the anal canal which separates two different types of
anal skin. Whereas the skin above the dentate line is not sensitive to pain, the
skin below this line is quite sensitive to pain.
Internal hemorrhoids occur above the dentate line and are, therefore, usually painless. They can cause bleeding or they may push out of the anal opening (prolapse) when they become quite large. External hemorrhoids occur below the dentate line and are generally painful. They are sometimes called skin tags, or can be seen or felt as extra skin around the anus. External hemorrhoids can become very distressing when the blood in the external hemorrhoid clots and inflammation irritates the nearby, pain-sensitive skin. This condition is called a thrombosed external hemorrhoid and is quite painful.
There are numerous creams and suppositories which can help relieve the irritation and pain symptoms of relatively minor hemorrhoids, such as hydrocortisone (Proctofoam HC) and (Anusol). If the pain is not too severe, conservative management consisting of stool softeners, topical pain relieving creams and Sitz baths (sitting in a tub or bathtub of warm water) may suffice.
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