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Internal hemorrhoids
What are the symptoms of internal hemorrhoids?
Internal hemorrhoids are a common condition in proctology, clinically characterized primarily by intermittent, painless rectal bleeding. The blood is bright red, often appearing in a jetting or dripping pattern after defecation or on toilet paper during wiping. Simultaneously, the clinical symptoms of internal hemorrhoids vary with their stages. For instance, grade I internal hemorrhoids mainly exhibit intermittent rectal bleeding without any prolapse of anal materials. Grade II internal hemorrhoids show symptoms of intermittent rectal bleeding accompanied by prolapse of anal materials, which can spontaneously reduce. Grade III internal hemorrhoids are characterized by prolapsed anal materials that cannot reduce on their own and require manual intervention. This stage also involves rectal bleeding. Grade IV internal hemorrhoids are the most severe, presenting with irreducible prolapsed materials that can become trapped or may protrude during coughing or walking. Rectal bleeding is also a symptom. Surgical treatment is essential for grade IV internal hemorrhoids.
Rectal prolapse and internal hemorrhoids differences
Although both rectal prolapse and prolapse of internal hemorrhoids involve swollen or foreign objects protruding from inside to outside the anus, the protruding object in the case of internal hemorrhoids is a congested, swollen hemorrhoid, generally petal-shaped. In contrast, the prolapsed rectal mucosa has distinctive radial or circular hooks. Secondly, the tightness of the anus in cases of internal hemorrhoid prolapse is generally normal, whereas in rectal prolapse, the tightness of the anus is usually loose.
Will the surgery for internal hemorrhoids prolapse be very painful?
Surgery for internal hemorrhoids is not very painful because anesthesia is required during the procedure. Clinically, the options for anesthesia include local infiltrative anesthesia, spinal anesthesia, and intravenous anesthesia. With such anesthesia, patients do not experience much pain during the surgery, especially with the latter two methods where patients do not feel any pain at all during the procedure. Moreover, surgery for prolapsed internal hemorrhoids primarily involves methods such as internal hemorrhoidal ligation, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization). The surgical wounds are relatively small, so postoperative pain is not very noticeable. Additionally, internal hemorrhoids are located above the dentate line of the anal canal, so if the external hemorrhoids are not severe, the patient will not experience significant pain after surgery, mainly feeling a sense of distension.
Do internal hemorrhoids definitely need to be pushed back in?
If internal hemorrhoids prolapse, they must be pushed back in because prolonged prolapse at the anus can lead to increased secretions in the anal area, causing itching. Moreover, internal hemorrhoids that prolapse can rub against underwear, resulting in damage, or even provoke inflammatory infections causing swelling and pain in the anus. Additionally, prolonged prolapsed hemorrhoids may also lead to poor local circulation, potentially forming blood clots, causing severe swelling and pain, and even possibly leading to necrosis of the hemorrhoids. Therefore, if internal hemorrhoids prolapse, they should be pushed back in as much as possible. If they cannot be pushed back, it is advisable to promptly visit the hospital's colorectal surgery department to consider procedures such as hemorrhoidal banding, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization). After the surgery, it is crucial to adhere to changing dressings to avoid wound infection and inflammation. Furthermore, if the internal hemorrhoids repeatedly prolapse after being pushed back, surgical treatment is also necessary.
Internal hemorrhoids that prolapse need to be operated on within a few days.
In clinical practice, if internal hemorrhoids prolapse and cannot retract for three to four days, then it is necessary to proceed with surgical treatment as soon as possible. This is because prolonged prolapse of internal hemorrhoids at the anus can lead to local swelling and even thrombosis. Severe cases may experience anal distension and pain, or necrosis of the hemorrhoids, thus early surgical intervention is recommended. The surgical options for prolapsed internal hemorrhoids include internal hemorrhoid ligation, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization) among others. Postoperative dressing changes are crucial, as improper care can easily lead to pseudohealing or infection and edema. Typically, anal washes, hemorrhoidal suppositories, or hemorrhoidal ointments can be chosen for postoperative dressing. Moreover, it is important for patients to develop good bowel habits post-surgery, maintaining smooth bowel movements and avoiding hard, dry stools to prevent irritation to the wound, which could lead to bleeding or swelling.
Symptoms of internal hemorrhoids prolapse
Internal hemorrhoids prolapse, generally refers to the hemorrhoidal tissue prolapsing from inside the anus to outside of it, and typically divided into four stages based on the extent of prolapse. First-degree internal hemorrhoids refer to hemorrhoidal tissue that does not prolapse outside the anus. Second-degree internal hemorrhoids refer to hemorrhoidal tissue prolapsing outside the anus but can retract back inside automatically after defecation. Third-degree internal hemorrhoids refer to hemorrhoidal tissue that, after prolapsing outside the anus, requires manual assistance to be pushed back inside. Fourth-degree internal hemorrhoids are when the prolapsed tissue cannot be retracted, not even manually, and this condition can be accompanied by pain in the anus.
Is the pain and swelling of hemorrhoids external or internal?
This situation might involve both internal and external hemorrhoids, which is referred to as mixed hemorrhoids. Internal hemorrhoids might also prolapse, leading to inflammatory edema and causing anal swelling and pain. External hemorrhoids can also present with inflammatory edema and thrombosis, leading to anal swelling and pain. Hence, in clinical practice, this situation is often considered as mixed hemorrhoids. Mixed hemorrhoids mainly occur at the same point in the anal canal, both above and below the dentate line, and symptoms of both internal and external hemorrhoids are present. Clinically, if the patient is unwilling to undergo surgery, conservative treatment with medication can be considered initially, such as oral administration of Diosmin tablets, followed by the use of an anal wash or a sitz bath with potassium permanganate solution after defecation, and then application of Dihuang ointment externally to alleviate discomfort. However, if the inflammatory edema does not subside and anal swelling and pain are significant, it is advised to consider surgical intervention early to prevent necrosis due to prolapsed hemorrhoids. (Please follow medical advice when using medications.)
Symptoms of internal hemorrhoids outbreak
Symptoms of internal hemorrhoids: Internal hemorrhoids refer to the venous clusters located above the dentate line at the end of the rectum, which are branches of the superior rectal vein. The main symptoms of internal hemorrhoids include the following: The first is rectal bleeding, which is generally bright red in color and usually not accompanied by pain. The bleeding can be in droplets or in a spraying manner; the second is the prolapse of the hemorrhoidal nucleus, which can protrude outside the anus during bowel movements; the third is that once the hemorrhoidal nucleus has prolapsed outside the anus, symptoms such as moisture and itching around the anus may occur.
Treatment of internal hemorrhoids
The treatment of internal hemorrhoids mainly divides into two aspects: non-surgical treatment and surgical treatment. As for non-surgical treatment, it consists of general treatment, which includes drinking more water, consuming more dietary fiber, ensuring smooth bowel movements, taking hot sitz baths, and maintaining cleanliness around the anus. The second aspect is medication treatment, which involves oral medications. The third involves local treatment around the anal area, such as inserting hemorrhoid suppositories and applying hemorrhoid ointments. The second aspect is surgical treatment, which generally includes two methods. The first is the ligation of internal hemorrhoids, known as internal hemorrhoid ligation; the second is injecting a sclerosing agent into the internal hemorrhoids to harden them. (Medication use should be conducted under the guidance of a professional doctor.)
How long will it take for internal hemorrhoids to become necrotic if they prolapse?
The duration before prolapsed internal hemorrhoids become necrotic is directly related to the severity of the prolapse. If the prolapsed internal hemorrhoids are minimal and there are no significant inflammatory infections or thrombosis, necrosis is generally unlikely to occur in such cases. However, it might lead to an increase in secretions in the anal area, causing pain and discomfort. In this scenario, it is advisable to immediately reduce the prolapse manually, along with using medications to reduce swelling, to help retract the hemorrhoids back inside the anus. However, if the prolapsed internal hemorrhoids are large and there is edema due to entrapment, and local thrombosis has occurred, then necrosis might develop within three to five days. In such cases, it is recommended that the patient promptly visits the proctology department of a hospital to undergo internal hemorrhoid surgery, such as hemorrhoidal banding, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization). Post-surgery, it is essential to keep changing dressings to avoid infection and bleeding from the surgical wound.