Do internal hemorrhoids need treatment?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 08, 2024
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Internal hemorrhoids require active treatment. If not actively treated, internal hemorrhoids may prolapse and worsen, or bleeding may intensify. This can lead to severe local symptoms and potentially develop from early-stage symptoms that are mild, into more severe cases that may only be significantly improved through surgery. The treatment methods for internal hemorrhoids primarily involve the use of topical and oral medications. When prolapse or severe swelling occurs, patients can take oral medications that clear heat, cool the blood, reduce swelling, and alleviate pain, specifically for hemorrhoids. These should be combined with local anal suppositories for symptomatic treatment. For cases accompanied by bleeding, oral hemostatic medications can be administered. If the prolapse is substantial, or if the internal hemorrhoids cannot retract back into the anus, surgical removal is recommended. (The use of medications should be under the guidance of a doctor.)

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Written by Yu Xu Chao
Colorectal Surgery
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Why do internal hemorrhoids prolapse without pain, itching, or bleeding?

Internal hemorrhoids that prolapse but do not hurt, itch, or bleed are primarily due to the large size of the prolapsed hemorrhoids and severe varicose veins underneath them, which leads to prolapse. At this time, they are less likely to bleed and will not cause itching. Since internal hemorrhoids are located above the dentate line in the anal canal, at the end of the rectum, and are innervated by the autonomic nervous system, they also do not cause pain. However, if internal hemorrhoids remain prolapsed at the anus for a long time, they can easily lead to local inflammatory edema, causing local pain and even a significant increase in secretion from the anal area. Therefore, when internal hemorrhoids prolapse, they should be pushed back into the anus as soon as possible. If repositioning is not possible, it is recommended to promptly undergo a hemorrhoid banding procedure, and regularly perform pelvic floor exercises to ensure smooth bowel movements.

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Written by Yu Xu Chao
Colorectal Surgery
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How to solve internal hemorrhoids that are prolapsed and incarcerated?

In clinical practice, for cases where internal hemorrhoids prolapse and become incarcerated, surgical treatment is often recommended. This is because the prolapse of internal hemorrhoids indicates a significant displacement and that the hemorrhoids have been prolapsed for a long time, which can lead to incarceration. In such cases, there is a risk of localized swelling or thrombosis formation, causing anal swelling and pain, and in severe cases, necrosis of the prolapsed tissue. Therefore, it is advised to opt for surgical treatment as soon as possible for incarcerated internal hemorrhoidal prolapse. Surgical options include hemorrhoidal banding, PPH (Procedure for Prolapse and Hemorrhoids), and TST (Transanal hemorrhoidal dearterialization) among others. Anesthetic choices can range from local infiltration anesthesia, spinal anesthesia, to general intravenous anesthesia. With spinal and general anesthesia, the patient does not experience pain during surgery and does not feel fear of pain. Post-surgery, it is also necessary to select appropriate medications for dressing changes, such as anal washes, hemorrhoidal suppositories, and golden yellow ointment to promote wound healing.

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Written by Deng Heng
Colorectal Surgery
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Do internal hemorrhoids cause a sensation of falling and swelling in the anus?

Internal hemorrhoids can cause a sensation of fullness or swelling in the anus. Although the main clinical symptoms of internal hemorrhoids are bleeding and prolapse of the hemorrhoidal nodes outside the anus, any stage of internal hemorrhoids can exhibit varying degrees of this sensation. Early to middle stages of internal hemorrhoids typically involve less severe swelling, while in the later stages, when the hemorrhoidal nodes prolapse, the sensation can be significantly more intense, especially after prolonged standing or physical exertion.

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Written by Yu Xu Chao
Colorectal Surgery
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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.

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Written by Deng Heng
Colorectal Surgery
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What should I do if the internal hemorrhoids bleeding is very severe?

Internal hemorrhoids bleeding, also known as rectal bleeding, is the main clinical manifestation in patients with internal hemorrhoids. In clinical practice, we often see a minority of patients with internal hemorrhoids experiencing long-term chronic bleeding, which can lead to severe anemia. In our clinical practice, the normal hemoglobin level in adults is 120g/L, but some patients are found to have hemoglobin levels of 30-40g/L upon consultation, indicating severe anemia. Therefore, these patients need to receive blood transfusions first, followed by surgical treatment.