How to determine if there are internal hemorrhoids when experiencing fresh blood in stool?

Written by He Cai Dong
Colorectal Surgery Department
Updated on May 15, 2025
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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 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 Chen Tian Jing
Colorectal Surgery
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What should I do if internal hemorrhoids have been bleeding for several days?

If internal hemorrhoids have been bleeding continuously for several days, and the bleeding is substantial, it is advisable to promptly undertake active hemostasis treatment. Common treatments for bleeding internal hemorrhoids mainly include taking oral hemostatic medication, or using suppositories and ointments for hemorrhoids to actively stop the bleeding. However, conservative treatment can only provide temporary relief of symptoms. If after treatment, the patient does not pay attention to a light diet or good bowel habits, there may also be a recurrence of hemorrhoid bleeding. If the bleeding is already severe, and there is a possibility of serious anemia, it is advised to perform a local internal hemorrhoid ligation surgery as soon as possible to prevent anemia or exacerbate the severity of the disease. (Medication should be used under the guidance of a doctor.)

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What is the most effective treatment for internal hemorrhoids bleeding?

The most effective treatment method for internal hemorrhoid bleeding primarily depends on the severity of the bleeding. If it is only early-stage internal hemorrhoid bleeding, the most effective method is to choose hemorrhoid suppositories or ointments for anal administration, which can quickly stop the bleeding. At the same time, patients should pay attention to their diet and avoid spicy, irritating and dry foods as much as possible, which can also alleviate the bleeding of internal hemorrhoids. However, if the internal hemorrhoid bleeding is frequent and the amount of bleeding is substantial, then the most effective treatment method is to go to the hospital's colorectal surgery department for surgical treatment. The surgical treatments can include sclerotherapy injections, PPH or TST, and internal hemorrhoid banding, etc. Consistently changing dressings after surgery can effectively improve and control internal hemorrhoid bleeding.

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Colorectal Surgery
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Can I exercise more if I have internal hemorrhoids bleeding?

If the patient is in a period of internal hemorrhoids bleeding, it is not advised for the patient to engage in excessive exercise and physical training, as the local mucosa is ruptured and bleeding during this period. Excessive exercise can potentially increase the pressure inside the local blood vessels, thereby increasing the amount of bleeding or worsening the condition. During internal hemorrhoids bleeding, related hemostatic treatments are necessary to prevent anemia from long-term repeated bleeding. Treatment mainly involves oral or topical hemostatic drugs. In terms of exercise and training, it is recommended to primarily walk gently and avoid vigorous exercises. If conservative medication does not effectively treat the bleeding, surgical ligation can also be considered for hemostasis. (Please use medications under the guidance of a doctor.)

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What color is a prolapsed internal hemorrhoid?

If internal hemorrhoids prolapse, it indicates that the hemorrhoidal venous plexus is severely varicose and congested, and the anal cushion has pathologically enlarged and descended, leading to the prolapse of the internal hemorrhoids. The color of prolapsed internal hemorrhoids at the anal opening commonly appears as purple lumps or swellings. If the prolapsed hemorrhoids cannot retract back into the anus, even with manual assistance, this condition may lead to necrosis of the internal hemorrhoids. If necrosis occurs and results in localized thrombosis, the hemorrhoids may turn black. In such cases, prompt surgical treatment is required to prevent necrosis and worsening infection of the hemorrhoids. Surgical options include internal hemorrhoid ligation, PPH (procedure for prolapse and hemorrhoids), or TST (transanal hemorrhoidal dearterialization), as well as the traditional excision and ligation. Postoperatively, consistent wound dressing changes are necessary to promote healing.