Treatment of internal hemorrhoids

Written by Deng Heng
Colorectal Surgery
Updated on May 29, 2025
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The treatment of internal hemorrhoids mainly divides into two aspects: non-surgical treatment and surgical treatment. As for non-surgical treatment, it consists of general treatment, which includes drinking more water, consuming more dietary fiber, ensuring smooth bowel movements, taking hot sitz baths, and maintaining cleanliness around the anus. The second aspect is medication treatment, which involves oral medications. The third involves local treatment around the anal area, such as inserting hemorrhoid suppositories and applying hemorrhoid ointments. The second aspect is surgical treatment, which generally includes two methods. The first is the ligation of internal hemorrhoids, known as internal hemorrhoid ligation; the second is injecting a sclerosing agent into the internal hemorrhoids to harden them. (Medication use should be conducted under the guidance of a professional doctor.)

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Written by Yu Xu Chao
Colorectal Surgery
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Can internal hemorrhoids be treated by prolapse and bloodletting?

Bleeding should not be used for prolapsed internal hemorrhoids, as this condition is primarily caused by improper defecation habits leading to pathological enlargement and descent of the anal cushion, which results in the prolapse of internal hemorrhoids. In the early stage, prolapsed internal hemorrhoids can retract back into the anus after defecation, and under such circumstances, it is only required for the patient to develop good bowel habits. For example, avoid spending too much time on defecation, don't exert excessive force, perform sphincter exercises after defecation, and maintain smooth bowel movements. Attention should also be paid to perianal hygiene; it is advised to wash the area with warm saline water after defecation to avoid worsening the prolapse or causing incarcerated edema. However, for cases where incarcerated edema occurs, it is generally recommended to consider prompt surgical intervention, such as hemorrhoidal ligation, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Stapling Technique). The use of bleeding as a treatment does not have significant therapeutic effects for prolapsed internal hemorrhoids, and thus is not recommended in clinical practice. Furthermore, patients should pay attention to a light diet and avoid spicy, stimulating, and dry-hot foods as much as possible.

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Written by Chen Tian Jing
Colorectal Surgery
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Can I exercise more if I have internal hemorrhoids bleeding?

If the patient is in a period of internal hemorrhoids bleeding, it is not advised for the patient to engage in excessive exercise and physical training, as the local mucosa is ruptured and bleeding during this period. Excessive exercise can potentially increase the pressure inside the local blood vessels, thereby increasing the amount of bleeding or worsening the condition. During internal hemorrhoids bleeding, related hemostatic treatments are necessary to prevent anemia from long-term repeated bleeding. Treatment mainly involves oral or topical hemostatic drugs. In terms of exercise and training, it is recommended to primarily walk gently and avoid vigorous exercises. If conservative medication does not effectively treat the bleeding, surgical ligation can also be considered for hemostasis. (Please use medications under the guidance of a doctor.)

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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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"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 Chen Tian Jing
Colorectal Surgery
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What should I do if internal hemorrhoids have prolapsed and not retracted for two or three days?

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.