How to completely treat internal hemorrhoids?

Written by Deng Heng
Colorectal Surgery
Updated on March 27, 2025
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In recent years, there have been numerous treatment methods for internal hemorrhoids, primarily divided into non-surgical and surgical treatments. Non-surgical treatment mainly involves conservative management, which generally includes measures such as increasing the intake of vegetables and fruits, maintaining smooth bowel movements, and using medications or applying ointments locally. Surgical treatment mainly includes injection therapy and excision of the hemorrhoidal nodes. For a complete cure, surgical treatment is typically required, which involves thoroughly removing the pathological hemorrhoidal nodes. (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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"Internal hemorrhoids prolapse" means internal hemorrhoids have slipped downwards, typically so they protrude outside the anus.

Prolapse of internal hemorrhoids refers to the condition where the hemorrhoidal mass of internal hemorrhoids protrudes outside the anus. This condition occurs only in internal hemorrhoids of grade II or higher. Grade II internal hemorrhoids can spontaneously retract back inside the anus after defecation without the need for manual reduction. Grade III internal hemorrhoids, however, do not retract spontaneously and should be manually reduced after cleaning and a period of bed rest. If the hemorrhoids remain prolapsed for a long time without timely reduction, it can lead to painful swelling around the anus. If a patient is unable to manually reduce the prolapsed hemorrhoids themselves, it can lead to incarcerated hemorrhoids, and medical assistance should be sought promptly.

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Written by Yu Xu Chao
Colorectal Surgery
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Can warm water sitz baths improve internal hemorrhoids that have prolapsed?

Warm sitz baths for prolapsed internal hemorrhoids can improve anal heaviness to some extent, and prevent inflammatory edema caused by the prolapse. They can also help prevent further worsening of prolapsed hemorrhoids, as warm sitz baths promote circulation around the anal area, relieve heaviness, and can somewhat reduce the prolapse, but they cannot completely cure it. Prolapsed internal hemorrhoids are caused by pathological hypertrophy and descent of the anal cushions, representing an organic lesion. Simple conservative medical treatment can only prevent the hemorrhoids from worsening, but cannot fully cure them. For prolapsed internal hemorrhoids that can be manually reduced, conservative treatment is generally recommended. Regular smooth bowel movements should be maintained, long duration of defecation should be avoided, and frequent anal sphincter exercises should be performed. However, for prolapsed hemorrhoids that cannot be reduced, or those that develop incarceration with edema or thrombosis, surgical treatment is recommended.

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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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Colorectal Surgery
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Will internal hemorrhoids affect menstruation?

Internal hemorrhoid bleeding can potentially affect menstruation. Although brief internal hemorrhoid bleeding does not affect menstruation, if the hemorrhoid bleeding is heavy, prolonged, frequent, and occurs daily or frequently, exceeding the body's ability to replace the lost blood, it can cause severe systemic anemia. In such cases, it might affect menstruation.

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Can internal hemorrhoids burst by themselves?

Internal hemorrhoids that prolapse should not be burst forcibly. As internal hemorrhoids are located at the anus, they are continuously exposed to contaminants from fecal and secretion matter over time. If the prolapsed hemorrhoids burst, it could lead to local infections and even necrosis. Therefore, do not burst prolapsed hemorrhoids, but rather, try to push them back into the anus. If they cannot be reinserted, it is recommended to opt for surgical treatment early to avoid rupture or strangulated edema, which can lead to swelling, pain, or necrosis in the anal area. Surgical options include hemorrhoidal banding, PPH, or TST procedures. Post-surgery, treatments may include the use of anal washes, red ointment gauze, aureomycin ointment, etc. Moreover, patients should eat a light diet, maintain smooth bowel movements, and regularly perform pelvic floor exercises.