Why is internal hemorrhoid bleeding painless?

Written by Deng Heng
Colorectal Surgery
Updated on May 17, 2025
00:00
00:00

Bleeding from internal hemorrhoids, also known as rectal bleeding, is the most common primary clinical manifestation in patients with internal hemorrhoids. Internal hemorrhoids refer to the venous clusters that grow above the dentate line, and their onset occurs above this line. The area above the dentate line is mainly controlled by the autonomic nervous system, making it insensitive to pain and irritation. Therefore, many patients with bleeding internal hemorrhoids may not even realize it themselves, as it does not cause pain. In contrast, external and mixed hemorrhoids, which involve the area below the dentate line, are controlled by somatic nerves, making pain more readily felt.

Other Voices

doctor image
home-news-image
Written by Deng Heng
Colorectal Surgery
41sec home-news-image

Symptoms of internal hemorrhoids outbreak

Symptoms of internal hemorrhoids: Internal hemorrhoids refer to the venous clusters located above the dentate line at the end of the rectum, which are branches of the superior rectal vein. The main symptoms of internal hemorrhoids include the following: The first is rectal bleeding, which is generally bright red in color and usually not accompanied by pain. The bleeding can be in droplets or in a spraying manner; the second is the prolapse of the hemorrhoidal nucleus, which can protrude outside the anus during bowel movements; the third is that once the hemorrhoidal nucleus has prolapsed outside the anus, symptoms such as moisture and itching around the anus may occur.

doctor image
home-news-image
Written by Chen Tian Jing
Colorectal Surgery
58sec home-news-image

Will internal hemorrhoids falling out be painful?

If internal hemorrhoids can retract back into the anus on their own after prolapse, they generally do not cause severe pain. However, if the prolapse lasts for a long time or occurs repeatedly, and if the mucous membrane of the hemorrhoid core ruptures and bleeds due to friction from walking or exercising, this can lead to pain due to the localized prolapse. It may even lead to congestion and swelling of the local hemorrhoid core after prolapse, thereby causing inflammatory edematous hemorrhoids, further intensifying the pain. Therefore, to avoid pain from internal hemorrhoids, or for those that prolapse and cannot retract back, it is advisable to actively use medications for treatment at the early stages of prolapse. For recurrent cases, direct internal hemorrhoid ligation surgery can also be performed.

doctor image
home-news-image
Written by Chen Tian Jing
Colorectal Surgery
54sec home-news-image

How to treat internal hemorrhoids?

Hemorrhoids are divided into internal, external, and mixed types. The clinical symptoms of internal hemorrhoids mainly include local pain, prolapse, and rectal bleeding due to rupture. If there are recurrent episodes or associated inflammation, there may also be an increase in secretions, which can irritate the local skin around the anus and cause itching. Therefore, the primary treatment for internal hemorrhoids involves the use of suppository hemorrhoid plugs. If there is accompanying bleeding, it is also necessary to combine this with oral hemostatic medications. In cases of perianal itching, options such as sichuan pepper water or other insecticidal and anti-itch traditional Chinese medicine washes can be used for fumigation and hot compresses on the affected area.

doctor image
home-news-image
Written by Deng Heng
Colorectal Surgery
59sec home-news-image

Treatment of internal hemorrhoids

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.)

doctor image
home-news-image
Written by Deng Heng
Colorectal Surgery
36sec home-news-image

Is a severe internal hemorrhoid prolapse?

Internal hemorrhoids mainly refer to soft venous masses that occur above the dentate line, formed by congestion, dilation, and varicosity of the superior rectal venous plexus. The primary symptoms are rectal bleeding and prolapse of the lump outside the anus. Prolapse of internal hemorrhoids is one of the indications for surgery, meaning that if there is rectal bleeding or prolapse outside the anus at the dentate line, surgical treatment is required. Thus, internal hemorrhoids are considered severe if there is a prolapse, necessitating surgical treatment.