Do internal hemorrhoids always require surgery?

Written by Deng Heng
Colorectal Surgery
Updated on May 22, 2025
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The prolapse of hemorrhoidal nodules is the main symptom of internal hemorrhoids progressing to the middle and late stages. In the middle stage, the hemorrhoidal nodules prolapse during defecation but can be spontaneously reduced afterwards. In the late stage, internal hemorrhoids require manual reduction or a period of bed rest after defecation, and may even prolapse during normal activities, walking, exhaustion, as well as during coughing, sneezing, or squatting. Some patients cannot manually reduce the prolapsed nodules back into the anus, making them highly susceptible to infection. Due to inflammation, edema, and pain, incarceration occurs, making reduction difficult. Therefore, the prolapse of internal hemorrhoids is a symptom of the middle to late stages of hemorrhoids, and surgery is definitely needed.

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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.

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Written by Chen Tian Jing
Colorectal Surgery
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The difference between rectal prolapse and internal hemorrhoids prolapse

Rectal prolapse primarily refers to the prolapse of the rectal mucosa or part of the sigmoid colon mucosa, partially or completely falling out of the anus. Generally, there is a ring-shaped or cylindrical mucosa protrusion outside the anus. Internal hemorrhoid prolapse involves the partial prolapse of the mucosa near the dentate line, typically appearing as small lumps or accompanied by local venous thrombosis and varicose clusters, with rectal prolapse being more severe than internal hemorrhoid prolapse. The treatment of rectal prolapse mainly involves surgery, while early stages of internal hemorrhoid prolapse can be treated with medications. This involves using topical hemorrhoid creams or suppositories to alleviate symptoms. If there are recurrent prolapses or accompanying bleeding during bowel movements, surgical treatment may also be considered. Surgical methods for rectal prolapse primarily involve local mucosal ring excision, whereas surgeries for internal hemorrhoids mainly include hemorrhoid ligation or banding procedures.

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Written by Yu Xu Chao
Colorectal Surgery
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Can internal hemorrhoids that prolapse be treated conservatively without surgery?

If internal hemorrhoids can be manually reduced after prolapse, then surgery can be temporarily avoided, and conservative treatment can be administered. For example, the patient should ensure smooth defecation, perform anal lifting exercises after defecation, strengthen the anal sphincter, and prevent the recurrence of internal hemorrhoids. Additionally, the duration of defecation should not be too long, and excessive straining should be avoided to prevent worsening of the prolapsed hemorrhoids. Moreover, patients must pay attention to the hygiene around the anus, and cleanse the peri-anal area with warm saline water after each bowel movement. However, if the internal hemorrhoids cannot be manually reduced after prolapse, or if incarceration and swelling occur, causing anal distension and pain, it is necessary to visit the hospital's colorectal surgery department promptly to undergo internal hemorrhoid ligation, TST, PPH, or other surgical procedures, followed by dressing changes. Since unresolved internal hemorrhoid prolapse can easily lead to incarceration or even necrosis, it is crucial to arrange for surgery as soon as possible, and patients should develop good bowel habits to maintain smooth defecation.

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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 Deng Heng
Colorectal Surgery
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What should I do if internal hemorrhoids are bleeding?

The main symptoms of internal hemorrhoids are bleeding and protrusion, where the hemorrhoidal tissue prolapses outside the anus. There are several types of bleeding: the first is dripping blood during defecation, where blood drops steadily. Another type is spraying blood, similar to the way a syringe ejects fluid; these are all categorized under rectal bleeding. For internal hemorrhoids, the presence of either bleeding or prolapse outside the anus indicates a need for surgical treatment. This means that if internal hemorrhoids cause spraying blood, surgical treatment is required (i.e., removing the hemorrhoidal tissue), which can improve the bleeding and spraying issues.