Do internal hemorrhoids require surgery?

Written by Chen Tian Jing
Colorectal Surgery
Updated on February 04, 2025
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The clinical symptoms of internal hemorrhoids are numerous, and surgery is only recommended if the internal hemorrhoids frequently recur, or if the clinical symptoms are severe. Severe internal hemorrhoids are primarily characterized by substantial rectal bleeding or recurrent prolapses, and due to repeated prolapses, friction on the local mucosa may even cause anal pain. A severe symptom of prolapsed internal hemorrhoids is that after each prolapse, the patient needs to manually reposition them, accompanied by jet-like or dripping fresh red rectal bleeding. Surgical methods for internal hemorrhoids mainly include hemorrhoidectomy with ligation or local injection of sclerosing agents.

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

If internal hemorrhoids experience local mucosal rupture or repeated prolapse leading to friction of the mucosa, it is likely to cause pain and even bleeding. To avoid pain caused by internal hemorrhoids, it is recommended that patients use hemorrhoid suppositories for local administration in the rectum for early flare-ups to reduce swelling, relieve pain, and cool and stop bleeding. If internal hemorrhoids prolapse and cannot retract back into the anal canal on their own after each prolapse, it is suggested that patients consider surgery to ligate and excise the affected internal hemorrhoids, or inject sclerosants under the mucosa of the hemorrhoids to cause local mucosal consolidation and shedding. Patients with internal hemorrhoids are advised not to strain excessively during bowel movements to avoid worsening local congestion and edema.

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Written by Yu Xu Chao
Colorectal Surgery
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What color is a prolapsed internal hemorrhoid?

If internal hemorrhoids prolapse, it indicates that the hemorrhoidal venous plexus is severely varicose and congested, and the anal cushion has pathologically enlarged and descended, leading to the prolapse of the internal hemorrhoids. The color of prolapsed internal hemorrhoids at the anal opening commonly appears as purple lumps or swellings. If the prolapsed hemorrhoids cannot retract back into the anus, even with manual assistance, this condition may lead to necrosis of the internal hemorrhoids. If necrosis occurs and results in localized thrombosis, the hemorrhoids may turn black. In such cases, prompt surgical treatment is required to prevent necrosis and worsening infection of the hemorrhoids. Surgical options include internal hemorrhoid ligation, PPH (procedure for prolapse and hemorrhoids), or TST (transanal hemorrhoidal dearterialization), as well as the traditional excision and ligation. Postoperatively, consistent wound dressing changes are necessary to promote healing.

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Written by Chen Tian Jing
Colorectal Surgery
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The difference between rectal polyps and internal hemorrhoids

Rectal polyps are skin-like mucosal protrusions that grow on the rectal mucosa, whereas internal hemorrhoids are confined to congestion and protrusion of the mucosa around the dentate line. The formation of rectal polyps is mainly due to long-term stimulation by feces, or certain constitutional and genetic factors, while the most likely cause of internal hemorrhoids is chronic congestion and edema around the anal area or the formation of venous thrombosis, leading to local varicose clusters. After the discovery of rectal polyps, it is necessary to perform surgery as soon as possible; however, the treatment for internal hemorrhoids in the early stages is primarily conservative, aimed at delaying the frequency of disease attacks and improving the quality of life for the patient. If the internal hemorrhoids reach a later stage or become severe, manifested by recurrent prolapse and rectal bleeding, surgical removal is recommended.

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Written by Deng Heng
Colorectal Surgery
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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.

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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.)