How to treat bleeding from internal hemorrhoids?

Written by Yu Xu Chao
Colorectal Surgery
Updated on April 28, 2025
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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.)

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Written by Deng Heng
Colorectal Surgery
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Symptoms of internal hemorrhoids outbreak

Symptoms of internal hemorrhoids: Internal hemorrhoids refer to the venous clusters located above the dentate line at the end of the rectum, which are branches of the superior rectal vein. The main symptoms of internal hemorrhoids include the following: The first is rectal bleeding, which is generally bright red in color and usually not accompanied by pain. The bleeding can be in droplets or in a spraying manner; the second is the prolapse of the hemorrhoidal nucleus, which can protrude outside the anus during bowel movements; the third is that once the hemorrhoidal nucleus has prolapsed outside the anus, symptoms such as moisture and itching around the anus may occur.

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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 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.

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Written by Yu Xu Chao
Colorectal Surgery
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Is minimally invasive surgery or traditional surgery better for internal hemorrhoids prolapse?

If the patient has only internal hemorrhoids prolapse without external hemorrhoids, it is better to opt for minimally invasive surgery, as it causes less damage and allows for faster postoperative recovery. Clinically, the TST surgical method is often recommended to avoid postoperative anal stenosis. However, if the internal hemorrhoids prolapse is accompanied by severe external hemorrhoids, it is advisable to opt for the traditional external peeling and internal ligation surgery, as this method can also effectively address external hemorrhoids, avoiding the need for a second surgery. Postoperatively, the use of anal cleansers, potassium permanganate solution, golden ointment, red oil ointment gauze, and hemorrhoid suppositories for dressing changes can promote recovery. Additionally, postoperative patients should avoid certain foods and maintain smooth bowel movements to prevent infections, swelling, and bleeding, which will aid in recovery.

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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.