What should I do if internal hemorrhoids have prolapsed and not retracted for two or three days?

Written by Chen Tian Jing
Colorectal Surgery
Updated on May 04, 2025
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If internal hemorrhoids prolapse and cannot be reduced back into the anus on their own, and even after they are manually repositioned by a patient or a doctor they prolapse again, it may indicate that local incarceration or necrosis has occurred. It is recommended to undergo surgery as soon as possible to prevent circulatory disturbances from prolonged prolapse, which can lead to necrotic changes in the local muscle tissues. The surgical methods primarily include hemorrhoidectomy with mixed hemorrhoid stripping and ligation, combined with an internal excision procedure. Additionally, sclerotherapy injections for internal hemorrhoids can be used to improve the overall treatment effects. After surgery, avoid straining during bowel movements to prevent local pain or bleeding.

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Written by Yu Xu Chao
Colorectal Surgery
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Can internal hemorrhoids be treated with wet compresses?

After prolapse of internal hemorrhoids, moist compresses can be applied, but the therapeutic effect of moist compresses is not significant. The prolapse of internal hemorrhoids mainly occurs when the anal cushion pathologically enlarges and shifts downward, leading to the prolapse. If the prolapsed hemorrhoids cannot be retracted back into the anus, this can lead to incarcerated edema, causing swelling and pain around the anus. If the incarceration lasts too long, it can induce local thrombosis or even necrosis. In such cases, it is recommended to opt for surgical treatment as soon as possible. Common surgical methods include internal hemorrhoid ligation, internal hemorrhoid excision, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization). After surgery, it is advisable to use anal washes or potassium permanganate solutions for sitz baths, and then apply topical treatments such as hemorrhoid creams, red oil gauze strips, and yellow ointments to promote postoperative recovery. Moreover, patients should develop good bowel habits after surgery to maintain smooth bowel movements, which further aids recovery. (Under the guidance of a doctor for medication use)

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Written by Chen Tian Jing
Colorectal Surgery
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Do internal hemorrhoids require surgery?

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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How to stop bleeding from internal hemorrhoids prolapse?

If internal hemorrhoids bleeding leads to unstoppable bleeding, the most common and direct way to stop the bleeding primarily involves local ligation. The prolapse and bleeding of internal hemorrhoids are mainly due to the repeated prolapse and friction of the local mucosa causing rupture and bleeding, or the persistent bleeding from ruptured small arteries. If prompt hemostatic treatment is not administered, it could potentially lead to chronic blood loss and subsequent anemia due to decreased blood volume. Therefore, if patients experience bleeding from internal hemorrhoids, especially if the bleeding is prolonged or substantial, it is advised to visit a proctology department for relevant examinations soon. If necessary, it may be crucial to promptly proceed with internal hemorrhoidal ligation surgery.

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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.

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Written by He Cai Dong
Colorectal Surgery Department
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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.