What to do if internal hemorrhoids bleed severely but there is no pain or itching?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 18, 2024
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If there is severe bleeding from internal hemorrhoids, it is recommended to promptly conduct an anoscopy to determine the exact locations and amount of bleeding. Generally, bleeding from internal hemorrhoids is painless, so it is often underestimated by patients. If the bleeding is heavy or persists for a long time, it is advised that patients undergo surgery as soon as possible to ligate and stop the bleeding, or combine this with oral hemostatic drugs for symptomatic treatment to avoid exacerbation of the bleeding and resulting anemia. Repeated bleeding from internal hemorrhoids can likely lead to varying degrees of anemia. If repeated bleeding occurs, or if the anemia worsens and leads to severe anemia, further treatment with blood transfusions may be necessary to correct the anemia.

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Written by Yu Xu Chao
Colorectal Surgery
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Does pressing on an internal hemorrhoid cause pain?

If internal hemorrhoids prolapse and become incarcerated or a thrombus forms locally, pressing on the area will cause pain, especially when the patient is walking or sitting, making the pain more apparent. For such cases, which are considered a severe stage of internal hemorrhoids, it's advisable to undertake surgical treatment as soon as possible. Clinically, treatment options for internal hemorrhoids include procedures like rubber band ligation, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization), with continued dressing changes required post-surgery. However, if the prolapsed internal hemorrhoids can retract spontaneously or can be manually reduced, pressing on them generally does not cause pain because internal hemorrhoids are located above the dentate line in the anal canal, an area innervated by autonomic nerves, which are less sensitive to pain. In the absence of inflammation or thrombosis, pressing on the area will not typically cause pain. In such cases, patients should develop good bowel habits to prevent the further worsening of internal hemorrhoids.

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Written by Chen Tian Jing
Colorectal Surgery
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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.)

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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.

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Written by Deng Heng
Colorectal Surgery
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How to reposition a prolapsed internal hemorrhoid?

Some internal hemorrhoids that prolapse can retract on their own, corresponding to second-degree internal hemorrhoids. If manual repositioning is required, these are typically third-degree or fourth-degree internal hemorrhoids. Third-degree internal hemorrhoids need to be manually repositioned because the external anal sphincter obstructs the retraction of the hemorrhoids. Generally, the method of taking a warm water sitz bath is used to relax the external anal sphincter, after which the hemorrhoids can be manually repositioned. During repositioning, applying some paraffin oil can facilitate the process, making it easier to accomplish.

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Written by Chen Tian Jing
Colorectal Surgery
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Will internal hemorrhoids falling out be painful?

If internal hemorrhoids can retract back into the anus on their own after prolapse, they generally do not cause severe pain. However, if the prolapse lasts for a long time or occurs repeatedly, and if the mucous membrane of the hemorrhoid core ruptures and bleeds due to friction from walking or exercising, this can lead to pain due to the localized prolapse. It may even lead to congestion and swelling of the local hemorrhoid core after prolapse, thereby causing inflammatory edematous hemorrhoids, further intensifying the pain. Therefore, to avoid pain from internal hemorrhoids, or for those that prolapse and cannot retract back, it is advisable to actively use medications for treatment at the early stages of prolapse. For recurrent cases, direct internal hemorrhoid ligation surgery can also be performed.