Do internal hemorrhoids definitely require surgery?

Written by Deng Heng
Colorectal Surgery
Updated on May 09, 2025
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Internal hemorrhoids bleeding does not necessarily require surgical treatment; conservative treatment is also an option. The main clinical symptom of internal hemorrhoids is bleeding, which can vary in amount and is generally bright red. Treatment for internal hemorrhoids mainly includes conservative treatment and surgical treatment. For first and second-degree internal hemorrhoid bleeding, conservative treatment can be adopted, which involves ensuring that stools are smooth, soft, and well-formed, reducing irritation to the anal area. Secondly, some hemostatic medications can be taken. Surgical treatment is primarily targeted at third and fourth-degree internal hemorrhoids.

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Written by Yu Xu Chao
Colorectal Surgery
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Can internal hemorrhoids that protrude outside the anus be cured by taking medicine?

Internal hemorrhoids that prolapse outside the anus cannot be cured by medication alone. This is because when internal hemorrhoids prolapse, it indicates a significant pathological enlargement and downward displacement of the anal cushions, which are structural changes. Merely taking medication will not result in significant improvement; surgery is the primary option at this point. For this condition, surgical options such as PPH (Procedure for Prolapse and Hemorrhoids) or TST (Transanal Hemorrhoidal Dearterialization) can be employed. Consistent postoperative care and dressing changes can facilitate recovery. Because prolapsed internal hemorrhoids are located at the anal opening, if not treated surgically, they can lead to impaired blood flow, which may cause incarceration leading to edema or thrombosis, and even potentially result in infected necrosis. Therefore, early surgical intervention is required for prolapsed internal hemorrhoids. Additionally, patients should regularly perform anal sphincter exercises, avoid straining excessively during bowel movements, and not spend too much time on the toilet.

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Written by Chen Tian Jing
Colorectal Surgery
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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.

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Written by Chen Tian Jing
Colorectal Surgery
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The hazards of internal hemorrhoids bleeding

Internal hemorrhoids or mixed hemorrhoids are most commonly diagnosed clinically, with prolapse and rectal bleeding being typical symptoms. If internal hemorrhoid bleeding occurs, the choice of treatment depends on the amount and duration of bleeding. Increased bleeding or prolonged bleeding duration requires early conservative medication or surgical ligation to prevent anemia due to local hemorrhoidal bleeding. Prolonged and significant rectal bleeding from internal hemorrhoids primarily endangers the patient by causing a decrease in overall blood volume due to chronic blood loss, leading to anemia. Following anemia, patients may experience symptoms such as palpitations and fatigue due to insufficient blood volume.

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Written by Chen Tian Jing
Colorectal Surgery
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Can you drink beer if you have internal hemorrhoids bleeding?

During the bleeding phase of internal hemorrhoids, patients should not drink beer or other alcoholic beverages, nor eat spicy and stimulating foods such as chili peppers and seafood. This is because both drinking alcohol and consuming spicy, stimulating foods can cause the mucous membrane in the anal area to become congested. If there are any bleeding spots locally, the likelihood and volume of bleeding will be greater than normal. Therefore, further hemostatic treatment is necessary during the bleeding period. If alcohol is consumed, the volume of bleeding will increase and the severity of the bleeding condition will become worse. It is recommended that patients use external hemorrhoid creams for hemostasis, or take oral hemostatic drugs for symptomatic treatment. If the bleeding is substantial or the condition is not under control, further surgical treatment may be needed. (Please use medication under the guidance of a doctor.)

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The color of the blood from internal hemorrhoids.

Bleeding from internal hemorrhoids is bright red. If the amount of bleeding is substantial, it can appear as a jet-like hemorrhoidal bleeding. This condition is caused by hard and dry stools scratching the hemorrhoidal veins during defecation, leading to bleeding. Repeated bleeding from internal hemorrhoids can cause chronic blood loss and result in symptoms of anemia. It is advisable to actively engage in medication or minimally invasive treatments, using drugs to stop bleeding and constrict hemorrhoidal veins. Some may undergo vein ligation surgery minimally invasively. At the same time, it is important to have a light diet, drink more water, eat more vegetables, and ensure smooth bowel movements.