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 Deng Heng
Colorectal Surgery
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"Internal hemorrhoids prolapse" means internal hemorrhoids have slipped downwards, typically so they protrude outside the anus.

Prolapse of internal hemorrhoids refers to the condition where the hemorrhoidal mass of internal hemorrhoids protrudes outside the anus. This condition occurs only in internal hemorrhoids of grade II or higher. Grade II internal hemorrhoids can spontaneously retract back inside the anus after defecation without the need for manual reduction. Grade III internal hemorrhoids, however, do not retract spontaneously and should be manually reduced after cleaning and a period of bed rest. If the hemorrhoids remain prolapsed for a long time without timely reduction, it can lead to painful swelling around the anus. If a patient is unable to manually reduce the prolapsed hemorrhoids themselves, it can lead to incarcerated hemorrhoids, and medical assistance should be sought promptly.

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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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Written by Deng Heng
Colorectal Surgery
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Is a severe internal hemorrhoid prolapse?

Internal hemorrhoids mainly refer to soft venous masses that occur above the dentate line, formed by congestion, dilation, and varicosity of the superior rectal venous plexus. The primary symptoms are rectal bleeding and prolapse of the lump outside the anus. Prolapse of internal hemorrhoids is one of the indications for surgery, meaning that if there is rectal bleeding or prolapse outside the anus at the dentate line, surgical treatment is required. Thus, internal hemorrhoids are considered severe if there is a prolapse, necessitating surgical treatment.

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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 Chen Tian Jing
Colorectal Surgery
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Is the bleeding from internal hemorrhoids bright red?

The majority of internal hemorrhoid bleeding is bright red, but if there is a significant amount of bleeding, blood may accumulate within the anal canal and form clots, resulting in darker colored blood in the stool. To identify and diagnose whether it is bleeding from internal hemorrhoids, it is recommended that patients undergo an anoscopic examination. If obvious bleeding points are found near the mucosa around the dentate line, it is mostly due to internal hemorrhoids. To treat bleeding from internal hemorrhoids, it is first necessary to take oral or topical hemostatic medications for symptomatic treatment. If the internal hemorrhoid bleeding has been prolonged, or in cases of chronic blood loss, further surgical ligation may be necessary to stop the bleeding and prevent anemia due to excessive blood loss. (The use of medications should be under the guidance of a doctor.)