How to reposition a prolapsed internal hemorrhoid?

Written by Deng Heng

Colorectal Surgery

Updated on April 18, 2025

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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

46sec

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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 Deng Heng

Colorectal Surgery

54sec

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Is bleeding from internal hemorrhoids serious?

Bleeding from internal hemorrhoids, also known as rectal bleeding, is a common primary symptom in patients with internal hemorrhoids. Although the bleeding from internal hemorrhoids is painless and not itchy, it occurs during bowel movements and can be either a trickle or a spray of blood. Although the amount of bleeding might not be large and may subside naturally, in clinical practice, we have seen a minority of patients with long-term chronic bleeding leading to severe anemia. For example, the normal hemoglobin level in adults should be 120g/L, but at the time of consultation, their hemoglobin has dropped to 30, 40, or 50g/L. Treatment then requires an initial blood transfusion followed by surgery, which can be quite complicated. Therefore, bleeding from internal hemorrhoids should be taken seriously.

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Written by He Cai Dong

Colorectal Surgery Department

1min 1sec

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What should I do if the internal hemorrhoids hurt after being pushed back in?

If the pain does not subside after pushing back a prolapsed internal hemorrhoid, it is often due to the formation of a thrombus, which is why the localized pain is quite noticeable. In such cases, it is advised to use topical medications for treatment. You can use hemorrhoid suppositories or ointment, inserting them into the anus to alleviate the pain. If the pain remains significant, you can also take oral pain relievers temporarily. If pain persists even after these treatments, it may be considered a strangulated hemorrhoid, which is more serious. It is recommended that you visit a formal hospital's proctology department. There, a doctor can perform a digital rectal examination and an anoscopy to establish a definitive diagnosis and provide appropriate treatment. If very severe, surgery may be needed. (Use of medications should be under the guidance of a physician.)

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Written by Ren Zheng Xin

Gastroenterology

44sec

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Is bleeding from hemorrhoids internal hemorrhoids?

Hemorrhoids causing blood in the stool are mostly due to internal hemorrhoids, which are a manifestation of varicose veins in the hemorrhoidal veins. During defecation, because the stool is rather dry and hard, it can easily scratch the hemorrhoidal veins as it moves downward. Due to internal hemorrhoids, the hemorrhoidal veins become distended and the vein walls become very thin, making them easily damaged, thus leading to bleeding. Minor cases may involve blood during defecation or dripping blood, while more severe cases can present with spraying blood during bowel movements. Depending on the amount of bleeding, one should choose treatments such as medications, minimally invasive procedures, or surgery.

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Written by Deng Heng

Colorectal Surgery

1min 7sec

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How to treat internal hemorrhoids stage II?

Internal hemorrhoids, according to the provisional standards for the diagnosis of hemorrhoids set by the Coloproctology Group of the Surgical Branch of the Chinese Medical Association in September 2002, stage II internal hemorrhoids primarily exhibit symptoms of bleeding during defecation. Additionally, the hemorrhoidal mass prolapses outside the anus during bowel movements but retracts back inside autonomously after defecation. This condition is referred to as stage II internal hemorrhoids, indicating the onset of symptoms like bleeding and prolapse, thus requiring surgical treatment. Indications for surgery include procedures like hemorrhoid banding or hemorrhoidectomy to remove the hemorrhoids. Conservative treatment options like using hemorrhoidal suppositories or ointments are also available if surgery is not immediately considered, but if these treatments are ineffective, surgery should be pursued. (Please use medications under the guidance of a physician to avoid misuse.)