The hazards of internal hemorrhoids bleeding

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 18, 2024
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Internal hemorrhoids or mixed hemorrhoids are most commonly diagnosed clinically, with prolapse and rectal bleeding being typical symptoms. If internal hemorrhoid bleeding occurs, the choice of treatment depends on the amount and duration of bleeding. Increased bleeding or prolonged bleeding duration requires early conservative medication or surgical ligation to prevent anemia due to local hemorrhoidal bleeding. Prolonged and significant rectal bleeding from internal hemorrhoids primarily endangers the patient by causing a decrease in overall blood volume due to chronic blood loss, leading to anemia. Following anemia, patients may experience symptoms such as palpitations and fatigue due to insufficient blood volume.

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Written by Yu Xu Chao
Colorectal Surgery
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Can internal hemorrhoids that protrude outside the anus be cured by taking medicine?

Internal hemorrhoids that prolapse outside the anus cannot be cured by medication alone. This is because when internal hemorrhoids prolapse, it indicates a significant pathological enlargement and downward displacement of the anal cushions, which are structural changes. Merely taking medication will not result in significant improvement; surgery is the primary option at this point. For this condition, surgical options such as PPH (Procedure for Prolapse and Hemorrhoids) or TST (Transanal Hemorrhoidal Dearterialization) can be employed. Consistent postoperative care and dressing changes can facilitate recovery. Because prolapsed internal hemorrhoids are located at the anal opening, if not treated surgically, they can lead to impaired blood flow, which may cause incarceration leading to edema or thrombosis, and even potentially result in infected necrosis. Therefore, early surgical intervention is required for prolapsed internal hemorrhoids. Additionally, patients should regularly perform anal sphincter exercises, avoid straining excessively during bowel movements, and not spend too much time on the toilet.

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Written by Chen Tian Jing
Colorectal Surgery
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Is the bleeding from internal hemorrhoids bright red?

The majority of internal hemorrhoid bleeding is bright red, but if there is a significant amount of bleeding, blood may accumulate within the anal canal and form clots, resulting in darker colored blood in the stool. To identify and diagnose whether it is bleeding from internal hemorrhoids, it is recommended that patients undergo an anoscopic examination. If obvious bleeding points are found near the mucosa around the dentate line, it is mostly due to internal hemorrhoids. To treat bleeding from internal hemorrhoids, it is first necessary to take oral or topical hemostatic medications for symptomatic treatment. If the internal hemorrhoid bleeding has been prolonged, or in cases of chronic blood loss, further surgical ligation may be necessary to stop the bleeding and prevent anemia due to excessive blood loss. (The use of medications should be under the guidance of a doctor.)

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Written by Deng Heng
Colorectal Surgery
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Do internal hemorrhoids require surgery?

Surgical indications for internal hemorrhoids include bleeding and prolapse of anal masses. These symptoms necessitate surgical treatment. Secondly, if scheduling surgery is not possible due to being busy, conservative treatment like applying ointment to the anus or taking medication can be used initially to alleviate the symptoms. If conservative treatment fails, it is still not too late to opt for surgery. (Specific medications should be used under the guidance of a physician.)

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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 Chen Tian Jing
Colorectal Surgery
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What to do if internal hemorrhoids bleed severely but there is no pain or itching?

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.