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 Deng Heng
Colorectal Surgery
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Do internal hemorrhoids require surgery?

Surgical indications for internal hemorrhoids include bleeding and prolapse of anal masses. These symptoms necessitate surgical treatment. Secondly, if scheduling surgery is not possible due to being busy, conservative treatment like applying ointment to the anus or taking medication can be used initially to alleviate the symptoms. If conservative treatment fails, it is still not too late to opt for surgery. (Specific medications should be used under the guidance of a physician.)

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Written by Yu Xu Chao
Colorectal Surgery
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How long will it take for internal hemorrhoids to become necrotic if they prolapse?

The duration before prolapsed internal hemorrhoids become necrotic is directly related to the severity of the prolapse. If the prolapsed internal hemorrhoids are minimal and there are no significant inflammatory infections or thrombosis, necrosis is generally unlikely to occur in such cases. However, it might lead to an increase in secretions in the anal area, causing pain and discomfort. In this scenario, it is advisable to immediately reduce the prolapse manually, along with using medications to reduce swelling, to help retract the hemorrhoids back inside the anus. However, if the prolapsed internal hemorrhoids are large and there is edema due to entrapment, and local thrombosis has occurred, then necrosis might develop within three to five days. In such cases, it is recommended that the patient promptly visits the proctology department of a hospital to undergo internal hemorrhoid surgery, such as hemorrhoidal banding, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization). Post-surgery, it is essential to keep changing dressings to avoid infection and bleeding from the surgical wound.

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Written by Deng Heng
Colorectal Surgery
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How to treat internal hemorrhoids stage II?

Internal hemorrhoids, according to the provisional standards for the diagnosis of hemorrhoids set by the Coloproctology Group of the Surgical Branch of the Chinese Medical Association in September 2002, stage II internal hemorrhoids primarily exhibit symptoms of bleeding during defecation. Additionally, the hemorrhoidal mass prolapses outside the anus during bowel movements but retracts back inside autonomously after defecation. This condition is referred to as stage II internal hemorrhoids, indicating the onset of symptoms like bleeding and prolapse, thus requiring surgical treatment. Indications for surgery include procedures like hemorrhoid banding or hemorrhoidectomy to remove the hemorrhoids. Conservative treatment options like using hemorrhoidal suppositories or ointments are also available if surgery is not immediately considered, but if these treatments are ineffective, surgery should be pursued. (Please use medications under the guidance of a physician to avoid misuse.)

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Written by Chen Tian Jing
Colorectal Surgery
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How to stop bleeding from internal hemorrhoids prolapse?

If internal hemorrhoids bleeding leads to unstoppable bleeding, the most common and direct way to stop the bleeding primarily involves local ligation. The prolapse and bleeding of internal hemorrhoids are mainly due to the repeated prolapse and friction of the local mucosa causing rupture and bleeding, or the persistent bleeding from ruptured small arteries. If prompt hemostatic treatment is not administered, it could potentially lead to chronic blood loss and subsequent anemia due to decreased blood volume. Therefore, if patients experience bleeding from internal hemorrhoids, especially if the bleeding is prolonged or substantial, it is advised to visit a proctology department for relevant examinations soon. If necessary, it may be crucial to promptly proceed with internal hemorrhoidal ligation surgery.

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Written by Deng Heng
Colorectal Surgery
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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.)