Internal hemorrhoids that prolapse need to be operated on within a few days.

Written by Yu Xu Chao
Colorectal Surgery
Updated on June 10, 2025
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In clinical practice, if internal hemorrhoids prolapse and cannot retract for three to four days, then it is necessary to proceed with surgical treatment as soon as possible. This is because prolonged prolapse of internal hemorrhoids at the anus can lead to local swelling and even thrombosis. Severe cases may experience anal distension and pain, or necrosis of the hemorrhoids, thus early surgical intervention is recommended. The surgical options for prolapsed internal hemorrhoids include internal hemorrhoid ligation, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization) among others. Postoperative dressing changes are crucial, as improper care can easily lead to pseudohealing or infection and edema. Typically, anal washes, hemorrhoidal suppositories, or hemorrhoidal ointments can be chosen for postoperative dressing. Moreover, it is important for patients to develop good bowel habits post-surgery, maintaining smooth bowel movements and avoiding hard, dry stools to prevent irritation to the wound, which could lead to bleeding or swelling.

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Written by Chen Tian Jing
Colorectal Surgery
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What to do if internal hemorrhoids bleed severely but there is no pain or itching?

If there is severe bleeding from internal hemorrhoids, it is recommended to promptly conduct an anoscopy to determine the exact locations and amount of bleeding. Generally, bleeding from internal hemorrhoids is painless, so it is often underestimated by patients. If the bleeding is heavy or persists for a long time, it is advised that patients undergo surgery as soon as possible to ligate and stop the bleeding, or combine this with oral hemostatic drugs for symptomatic treatment to avoid exacerbation of the bleeding and resulting anemia. Repeated bleeding from internal hemorrhoids can likely lead to varying degrees of anemia. If repeated bleeding occurs, or if the anemia worsens and leads to severe anemia, further treatment with blood transfusions may be necessary to correct the anemia.

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Written by Chen Tian Jing
Colorectal Surgery
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What should I do if hemorrhoids prolapse during pregnancy?

During pregnancy, due to increased abdominal pressure, patients who already have hemorrhoids may experience internal swelling or even prolapse. To treat and alleviate prolapsed hemorrhoids during pregnancy, conservative treatment should be the first approach. Surgical treatments may lead to local pain due to wounds, which can cause false contractions. Conservative treatments can include using dilute salt water or potassium permanganate solution for local washing and hot compresses to promote mucosal retraction. Additionally, a hemorrhoid cream with safe ingredients specifically for pregnant women can be applied locally. If the prolapse is severe, surgery is recommended after delivery. (Please use medication under the guidance of a professional physician and do not self-medicate.)

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Written by Deng Heng
Colorectal Surgery
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Do internal hemorrhoids definitely require surgery?

Internal hemorrhoids bleeding does not necessarily require surgical treatment; conservative treatment is also an option. The main clinical symptom of internal hemorrhoids is bleeding, which can vary in amount and is generally bright red. Treatment for internal hemorrhoids mainly includes conservative treatment and surgical treatment. For first and second-degree internal hemorrhoid bleeding, conservative treatment can be adopted, which involves ensuring that stools are smooth, soft, and well-formed, reducing irritation to the anal area. Secondly, some hemostatic medications can be taken. Surgical treatment is primarily targeted at third and fourth-degree internal hemorrhoids.

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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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Can internal hemorrhoids that prolapse be treated conservatively without surgery?

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.