Why do internal hemorrhoids prolapse without pain, itching, or bleeding?

Written by Yu Xu Chao
Colorectal Surgery
Updated on April 13, 2025
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Internal hemorrhoids that prolapse but do not hurt, itch, or bleed are primarily due to the large size of the prolapsed hemorrhoids and severe varicose veins underneath them, which leads to prolapse. At this time, they are less likely to bleed and will not cause itching. Since internal hemorrhoids are located above the dentate line in the anal canal, at the end of the rectum, and are innervated by the autonomic nervous system, they also do not cause pain. However, if internal hemorrhoids remain prolapsed at the anus for a long time, they can easily lead to local inflammatory edema, causing local pain and even a significant increase in secretion from the anal area. Therefore, when internal hemorrhoids prolapse, they should be pushed back into the anus as soon as possible. If repositioning is not possible, it is recommended to promptly undergo a hemorrhoid banding procedure, and regularly perform pelvic floor exercises to ensure smooth bowel movements.

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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 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.

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

In recent years, there have been numerous treatment methods for internal hemorrhoids, primarily divided into non-surgical and surgical treatments. Non-surgical treatment mainly involves conservative management, which generally includes measures such as increasing the intake of vegetables and fruits, maintaining smooth bowel movements, and using medications or applying ointments locally. Surgical treatment mainly includes injection therapy and excision of the hemorrhoidal nodes. For a complete cure, surgical treatment is typically required, which involves thoroughly removing the pathological hemorrhoidal nodes. (The use of medications should be under the guidance of a doctor.)

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Written by Chen Tian Jing
Colorectal Surgery
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How is internal hemorrhoids treated? Is there a way?

There are many treatment methods for internal hemorrhoids, the most common being medication. If the internal hemorrhoids repeatedly prolapse or bleed significantly, direct surgical removal can also be considered. Conservative treatments primarily involve the local use of hemorrhoid suppositories, combined with oral hemostatic and anti-swelling traditional Chinese medicine. If surgical criteria are met, direct surgical removal can be performed. Surgical methods mainly include injection of sclerosing agents into the mucosa of internal hemorrhoids, internal hemorrhoid banding, and internal hemorrhoid ligation and excision. To prevent recurrence after surgery, patients should maintain good dietary and bowel habits postoperatively, avoid overly spicy and stimulating foods, and try to keep bowel movements under ten minutes without straining excessively.

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Written by Yu Xu Chao
Colorectal Surgery
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How to treat bleeding from internal hemorrhoids?

In clinical practice, for internal hemorrhoids with bleeding, conservative medication or surgical treatment are often used. The specific treatment method mainly depends on the severity of the bleeding from internal hemorrhoids and whether the patient also has anemia. For early-stage internal hemorrhoid bleeding, which is intermittent and infrequent, conservative medication treatment is usually recommended. Commonly used medications include hemorrhoid suppositories or ointments for anal administration, and oral hemostatic medications can also effectively improve bleeding from internal hemorrhoids. Meanwhile, it is advised that patients maintain a light diet, avoid spicy, stimulating, and dry foods, and ensure smooth bowel movements to alleviate bleeding from internal hemorrhoids. However, if a patient's bleeding from internal hemorrhoids has led to chronic hemorrhagic anemia or even severe anemia, surgical treatment is recommended. Options might include sclerotherapy injections for internal hemorrhoids, internal hemorrhoidal ligation, PPH (Procedure for Prolapse and Hemorrhoids), or TST (transanal hemorrhoidal dearterialization) and other surgical methods. (Please follow medical advice when using medications.)