What are the symptoms of internal hemorrhoids?

Written by Yu Xu Chao
Colorectal Surgery
Updated on June 25, 2025
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Internal hemorrhoids are a common condition in proctology, clinically characterized primarily by intermittent, painless rectal bleeding. The blood is bright red, often appearing in a jetting or dripping pattern after defecation or on toilet paper during wiping. Simultaneously, the clinical symptoms of internal hemorrhoids vary with their stages. For instance, grade I internal hemorrhoids mainly exhibit intermittent rectal bleeding without any prolapse of anal materials. Grade II internal hemorrhoids show symptoms of intermittent rectal bleeding accompanied by prolapse of anal materials, which can spontaneously reduce. Grade III internal hemorrhoids are characterized by prolapsed anal materials that cannot reduce on their own and require manual intervention. This stage also involves rectal bleeding. Grade IV internal hemorrhoids are the most severe, presenting with irreducible prolapsed materials that can become trapped or may protrude during coughing or walking. Rectal bleeding is also a symptom. Surgical treatment is essential for grade IV internal hemorrhoids.

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Written by Yu Xu Chao
Colorectal Surgery
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Are there any effects if internal hemorrhoids are constantly prolapsed?

Internal hemorrhoids that protrude permanently can easily lead to incarceration, causing inflammatory edema. Constant friction over a long period can also cause the surface of the hemorrhoids to break and bleed. Additionally, contamination and waste matter may infect the hemorrhoids. Due to the prolonged protrusion outside the anus, the local circulation can become obstructed, leading to swelling and even inducing local thrombosis, which causes pain in the anus. Therefore, it is not possible to reinsert the prolapsed internal hemorrhoids back into the anus. In such cases, it is advisable to seek prompt medical treatment at a hospital's colorectal surgery department. Surgical options like hemorrhoid banding, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization) are recommended. Post-surgery care should include the use of anal cleansers, red oil gauze strips, and golden ointment for dressing changes. Additionally, it is crucial to maintain smooth bowel movements.

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Written by Deng Heng
Colorectal Surgery
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Why is internal hemorrhoid bleeding painless?

Bleeding from internal hemorrhoids, also known as rectal bleeding, is the most common primary clinical manifestation in patients with internal hemorrhoids. Internal hemorrhoids refer to the venous clusters that grow above the dentate line, and their onset occurs above this line. The area above the dentate line is mainly controlled by the autonomic nervous system, making it insensitive to pain and irritation. Therefore, many patients with bleeding internal hemorrhoids may not even realize it themselves, as it does not cause pain. In contrast, external and mixed hemorrhoids, which involve the area below the dentate line, are controlled by somatic nerves, making pain more readily felt.

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Written by Yu Xu Chao
Colorectal Surgery
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Will the surgery for internal hemorrhoids prolapse be very painful?

Surgery for internal hemorrhoids is not very painful because anesthesia is required during the procedure. Clinically, the options for anesthesia include local infiltrative anesthesia, spinal anesthesia, and intravenous anesthesia. With such anesthesia, patients do not experience much pain during the surgery, especially with the latter two methods where patients do not feel any pain at all during the procedure. Moreover, surgery for prolapsed internal hemorrhoids primarily involves methods such as internal hemorrhoidal ligation, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization). The surgical wounds are relatively small, so postoperative pain is not very noticeable. Additionally, internal hemorrhoids are located above the dentate line of the anal canal, so if the external hemorrhoids are not severe, the patient will not experience significant pain after surgery, mainly feeling a sense of distension.

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Written by Deng Heng
Colorectal Surgery
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Precautions for Internal Hemorrhoids Bleeding

Rectal bleeding is the primary clinical manifestation of internal hemorrhoids. When rectal bleeding occurs, it's essential first to rule out whether the bleeding is definitely from internal hemorrhoids because rectal bleeding can be caused by many diseases, including malignant tumors. Once it's determined that the bleeding is from internal hemorrhoids, it is important to pay attention to whether the volume of blood is large, the duration of bleeding is long, and the frequency of bleeding is high, and whether there is frequent or daily bleeding. If so, it will exceed the body's ability to replenish blood through its hematopoietic function, leading to severe systemic anemia.

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Written by Ren Zheng Xin
Gastroenterology
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Is bleeding from hemorrhoids internal hemorrhoids?

Hemorrhoids causing blood in the stool are mostly due to internal hemorrhoids, which are a manifestation of varicose veins in the hemorrhoidal veins. During defecation, because the stool is rather dry and hard, it can easily scratch the hemorrhoidal veins as it moves downward. Due to internal hemorrhoids, the hemorrhoidal veins become distended and the vein walls become very thin, making them easily damaged, thus leading to bleeding. Minor cases may involve blood during defecation or dripping blood, while more severe cases can present with spraying blood during bowel movements. Depending on the amount of bleeding, one should choose treatments such as medications, minimally invasive procedures, or surgery.