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.