Can internal hemorrhoids that prolapse be treated conservatively without surgery?

Written by Yu Xu Chao
Colorectal Surgery
Updated on February 10, 2025
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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 Yu Xu Chao
Colorectal Surgery
1min 19sec home-news-image

What should I do about internal hemorrhoids?

In clinical practice, the treatment of internal hemorrhoids mainly depends on the symptoms presented by the patient, and an appropriate treatment method is selected accordingly. For example, patients with early-stage internal hemorrhoids who experience intermittent rectal bleeding are usually advised to use hemorrhoid suppositories or ointments after defecation. However, as the condition of internal hemorrhoids worsens, which might include prolapse or even symptoms of anemia, surgical treatment is often recommended. Clinically, surgery for internal hemorrhoids can involve sclerotherapy injections, hemorrhoidal banding, or other surgical methods such as PPH (Procedure for Prolapse and Hemorrhoids) or TST (Transanal Hemorrhoidal Dearterialization). Post-surgery, dressing changes are necessary, and products such as rectal cleansing solutions, oil gauze strips, or ointments are commonly used. Moreover, it is crucial for patients to maintain smooth bowel movements post-surgery to avoid wound infection, bleeding, or edema, and they should adhere to a light diet avoiding spicy, stimulating, and dry foods. (Please follow medical advice regarding medication use.)

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Written by Deng Heng
Colorectal Surgery
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Hemorrhoids: What dietary considerations should be noted?

Patients with internal hemorrhoids should primarily focus on a reasonable diet, paying attention to eat less or avoid spicy and stimulating foods and condiments. Additionally, they should cultivate the habit of drinking more water, preferably light salt water or honey water. For constipation and hemorrhoids, it's important to consciously drink more water and eat more fruits and fresh vegetables, especially those that are rich in coarse fiber. Stimulating foods such as chili peppers, black pepper, ginger, garlic, and onions should be consumed minimally.

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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 Yu Xu Chao
Colorectal Surgery
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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.

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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.