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Internal hemorrhoids
Do internal hemorrhoids always require surgery?
The prolapse of hemorrhoidal nodules is the main symptom of internal hemorrhoids progressing to the middle and late stages. In the middle stage, the hemorrhoidal nodules prolapse during defecation but can be spontaneously reduced afterwards. In the late stage, internal hemorrhoids require manual reduction or a period of bed rest after defecation, and may even prolapse during normal activities, walking, exhaustion, as well as during coughing, sneezing, or squatting. Some patients cannot manually reduce the prolapsed nodules back into the anus, making them highly susceptible to infection. Due to inflammation, edema, and pain, incarceration occurs, making reduction difficult. Therefore, the prolapse of internal hemorrhoids is a symptom of the middle to late stages of hemorrhoids, and surgery is definitely needed.
Is internal hemorrhoids more uncomfortable or external hemorrhoids?
"Whether internal hemorrhoids or external hemorrhoids are more uncomfortable, overall, internal hemorrhoids tend to be more discomforting. This is because internal hemorrhoids have three main clinical manifestations: rectal bleeding, prolapse of the hemorrhoidal nucleus outside the anus, and pain. Rectal bleeding can lead to systemic anemia, prolapse of the hemorrhoidal nucleus can cause anal itching and anal eczema, and the pain is also very distressing. On the other hand, the main clinical manifestations of external hemorrhoids are a foreign body sensation in the anus and moisture in the anus, and only thrombosed external hemorrhoids cause anal pain."
Can internal hemorrhoids heal by themselves?
The vast majority of internal hemorrhoid bleeding is not self-healing. Only a small amount of mucosal bleeding or if the patient actively takes care of themselves after bleeding, there might be a tendency to self-heal. Internal hemorrhoid bleeding is mainly caused by excessive local congestion pressure or hard stools piercing the local mucosal skin, leading to bleeding, generally related to poor dietary habits and defecation habits of the patient. Therefore, to achieve self-healing from internal hemorrhoid bleeding, the patient firstly needs to adjust their diet and defecation habits to avoid repeated occurrences of bleeding during bowel movements. If the bleeding is significant or lasts for a long time and cannot heal on its own, it is recommended that the patient seek treatment as soon as possible to avoid long-term internal hemorrhoid bleeding which could lead to anemia.
Why is internal hemorrhoid bleeding painless?
Bleeding from internal hemorrhoids, also known as rectal bleeding, is the most common primary clinical manifestation in patients with internal hemorrhoids. Internal hemorrhoids refer to the venous clusters that grow above the dentate line, and their onset occurs above this line. The area above the dentate line is mainly controlled by the autonomic nervous system, making it insensitive to pain and irritation. Therefore, many patients with bleeding internal hemorrhoids may not even realize it themselves, as it does not cause pain. In contrast, external and mixed hemorrhoids, which involve the area below the dentate line, are controlled by somatic nerves, making pain more readily felt.
What is the most effective treatment for internal hemorrhoids bleeding?
The most effective treatment method for internal hemorrhoid bleeding primarily depends on the severity of the bleeding. If it is only early-stage internal hemorrhoid bleeding, the most effective method is to choose hemorrhoid suppositories or ointments for anal administration, which can quickly stop the bleeding. At the same time, patients should pay attention to their diet and avoid spicy, irritating and dry foods as much as possible, which can also alleviate the bleeding of internal hemorrhoids. However, if the internal hemorrhoid bleeding is frequent and the amount of bleeding is substantial, then the most effective treatment method is to go to the hospital's colorectal surgery department for surgical treatment. The surgical treatments can include sclerotherapy injections, PPH or TST, and internal hemorrhoid banding, etc. Consistently changing dressings after surgery can effectively improve and control internal hemorrhoid bleeding.
The early symptoms of internal hemorrhoids are
If early symptoms of internal hemorrhoids appear, the main manifestations are local mucosal protrusion or sub-mucosal congestion and edema. Patients may experience varying degrees of anal pain and might even experience minor bleeding during bowel movements due to irritation from hard, dry stools. The bleeding is usually bright red. After taking oral and topical medications, early-stage internal hemorrhoids can be cured and relieved. However, to prevent recurrent attacks of internal hemorrhoids or worsening of the condition, it is advised that patients maintain good bowel movements to avoid overly dry stools, keep bowel movement time under ten minutes, and avoid consuming spicy and irritating foods as much as possible.
How to determine if there are internal hemorrhoids when experiencing fresh blood in stool?
Fresh blood in the stool is usually caused by internal hemorrhoids. Bleeding from internal hemorrhoids can be seen on toilet paper, fresh blood in the toilet bowl, and sometimes severe bleeding can be spray-like. Based on the color of the blood, we can generally determine it to be internal hemorrhoids. When internal hemorrhoids are severe, anal lumps may protrude after defecation. If minor, the lumps can retract on their own; if severe, they need to be manually pushed back in, and if more severe, they remain irreducible at the anus. If you notice any of these symptoms, it is recommended that you visit the hospital's proctology department. A doctor can confirm whether the bleeding is caused by internal hemorrhoids through a digital rectal examination and an anoscopy, and then prescribe appropriate treatment.
What should I do if hemorrhoids prolapse during pregnancy?
During pregnancy, due to increased abdominal pressure, patients who already have hemorrhoids may experience internal swelling or even prolapse. To treat and alleviate prolapsed hemorrhoids during pregnancy, conservative treatment should be the first approach. Surgical treatments may lead to local pain due to wounds, which can cause false contractions. Conservative treatments can include using dilute salt water or potassium permanganate solution for local washing and hot compresses to promote mucosal retraction. Additionally, a hemorrhoid cream with safe ingredients specifically for pregnant women can be applied locally. If the prolapse is severe, surgery is recommended after delivery. (Please use medication under the guidance of a professional physician and do not self-medicate.)
Do internal hemorrhoids definitely require surgery?
Internal hemorrhoids bleeding does not necessarily require surgical treatment; conservative treatment is also an option. The main clinical symptom of internal hemorrhoids is bleeding, which can vary in amount and is generally bright red. Treatment for internal hemorrhoids mainly includes conservative treatment and surgical treatment. For first and second-degree internal hemorrhoid bleeding, conservative treatment can be adopted, which involves ensuring that stools are smooth, soft, and well-formed, reducing irritation to the anal area. Secondly, some hemostatic medications can be taken. Surgical treatment is primarily targeted at third and fourth-degree internal hemorrhoids.
Are there any effects if internal hemorrhoids are constantly prolapsed?
Internal hemorrhoids that protrude permanently can easily lead to incarceration, causing inflammatory edema. Constant friction over a long period can also cause the surface of the hemorrhoids to break and bleed. Additionally, contamination and waste matter may infect the hemorrhoids. Due to the prolonged protrusion outside the anus, the local circulation can become obstructed, leading to swelling and even inducing local thrombosis, which causes pain in the anus. Therefore, it is not possible to reinsert the prolapsed internal hemorrhoids back into the anus. In such cases, it is advisable to seek prompt medical treatment at a hospital's colorectal surgery department. Surgical options like hemorrhoid banding, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization) are recommended. Post-surgery care should include the use of anal cleansers, red oil gauze strips, and golden ointment for dressing changes. Additionally, it is crucial to maintain smooth bowel movements.