Most people who think they have hemorrhoids are actually mistaken. We've all been convinced by clever advertising for hemorrhoid creams that any skin irritation around the anus is a symptom of hemorrhoids. The truth is hemorrhoids rarely cause significant symptoms and when they do, over-the-counter remedies are not going to solve the problem.

So, what about that itching, burning, soreness, and dampness in the anal area? If you have these symptoms, they are almost certainly not from hemorrhoids. Instead, they are symptoms of a skin condition in the anal area called pruritis ani, which literally means "itchy anus."

What are hemorrhoids?

Hemorrhoids are enlarged "anal cushions." Anal cushions are the tail end of the anal canal. They are like "lips" at the other end of your intestinal tract. The job of anal cushions is to provide a complete seal of the anus when it is closed. Sometimes - due to excessive straining, pregnancy, or a family condition - anal cushions become enlarged and can begin to cause symptoms. We call enlarged anal cushions hemorrhoids. The symptoms of true hemorrhoids include bright red rectal bleeding (usually modest bleeding only), protrusion (sticking out), and pain that lasts steadily for a few days (due to a blood clot or thrombosis that can sometimes occur in a hemorrhoid).

Because tissues of your intestinal tract cover the hemorrhoids, they do not itch, burn, or cause any jabbing or sharp pain. Tissues of the intestinal tract simply cannot relay those kinds of symptoms to your brain. Symptoms like itching, burning, and soreness are signs of skin problems. The skin can and does produce all of those types of sensations. If you have small amounts of bleeding and sharp pain in the anus when you have bowel movements, you may also have what's called a fissure-in-ano, which is a crack in the lining of your anus. Fissures often go together with pruritis ani.

Sometimes a burst blood vessel adjacent to the anus is confused with a hemorrhoid

As a result of straining, coughing, or heavy lifting, blood vessels adjacent to the anus may rupture under the skin. When this happens, a purplish tender lump appears under the skin just at the edge of the anus. The lump is called a perianal hematoma or thrombosed external hemorrhoid. These have nothing to do with hemorrhoids.

Michael E. Pezim, MD 
in association with the MediResource Clinical Team