What should I do about internal hemorrhoids?

Written by Yu Xu Chao
Colorectal Surgery
Updated on March 17, 2025
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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 Chen Tian Jing
Colorectal Surgery
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Will internal hemorrhoids be painful?

If internal hemorrhoids experience local mucosal rupture or repeated prolapse leading to friction of the mucosa, it is likely to cause pain and even bleeding. To avoid pain caused by internal hemorrhoids, it is recommended that patients use hemorrhoid suppositories for local administration in the rectum for early flare-ups to reduce swelling, relieve pain, and cool and stop bleeding. If internal hemorrhoids prolapse and cannot retract back into the anal canal on their own after each prolapse, it is suggested that patients consider surgery to ligate and excise the affected internal hemorrhoids, or inject sclerosants under the mucosa of the hemorrhoids to cause local mucosal consolidation and shedding. Patients with internal hemorrhoids are advised not to strain excessively during bowel movements to avoid worsening local congestion and edema.

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Written by Yu Xu Chao
Colorectal Surgery
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How to relieve pain and swelling from internal hemorrhoids prolapse?

Internal hemorrhoids prolapse with pain and swelling. This is often due to inflammatory edema or thrombosis caused by the prolapse, which leads to pain and swelling. At this time, you can choose to apply lidocaine gel externally or apply golden ointment externally for anti-swelling and analgesic effects. You can also choose to insert sodium diclofenac suppositories into the anus, which has anti-inflammatory and analgesic effects, and take diosmin tablets orally to relieve anal swelling, as well as use anal cleansers or potassium permanganate solution for sitz baths to eliminate local bacteria and secretions, and reduce local infectious inflammation. After using the medication, it is still recommended to go to the hospital's proctology department as soon as possible for treatments like internal hemorrhoid banding, PPH, or TST, because the swelling of prolapsed internal hemorrhoids indicates a severe condition, and mere medication alone cannot achieve effective treatment outcomes.

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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.

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Written by Chen Tian Jing
Colorectal Surgery
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The difference between rectal prolapse and internal hemorrhoids prolapse

Rectal prolapse primarily refers to the prolapse of the rectal mucosa or part of the sigmoid colon mucosa, partially or completely falling out of the anus. Generally, there is a ring-shaped or cylindrical mucosa protrusion outside the anus. Internal hemorrhoid prolapse involves the partial prolapse of the mucosa near the dentate line, typically appearing as small lumps or accompanied by local venous thrombosis and varicose clusters, with rectal prolapse being more severe than internal hemorrhoid prolapse. The treatment of rectal prolapse mainly involves surgery, while early stages of internal hemorrhoid prolapse can be treated with medications. This involves using topical hemorrhoid creams or suppositories to alleviate symptoms. If there are recurrent prolapses or accompanying bleeding during bowel movements, surgical treatment may also be considered. Surgical methods for rectal prolapse primarily involve local mucosal ring excision, whereas surgeries for internal hemorrhoids mainly include hemorrhoid ligation or banding procedures.

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Written by Deng Heng
Colorectal Surgery
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Is infusion useful for internal hemorrhoids bleeding?

Useful. Bleeding is one of the main clinical manifestations of internal hemorrhoids, and the amount of bleeding can be large or small, generally bright red in color. The treatment methods for internal hemorrhoids are divided into conservative treatment and surgical treatment, and infusion can be used in both. In conservative treatment, infusion can administer hemostatic drugs to stop bleeding, or some nutritional drugs to reduce stool and protect the mucosa. For surgical patients, infusion can include antibiotics to prevent infection.