Symptoms and Treatment of Internal Hemorrhoids
Internal hemorrhoids are a widespread and usually asymptomatic anorectal health issue caused by the enlargement of veins within the rectum. Unlike external hemorrhoids, they often develop painlessly. However, in advanced stages, they can cause symptoms that significantly reduce quality of life.
Symptoms of Internal Hemorrhoids
Internal hemorrhoids form when the veins in the lower part of the rectum become enlarged and swollen. They are usually painless and often manifest through bleeding. Because they develop inside the rectal lining rather than under the skin, they are not visible externally. Symptoms typically occur during bowel movements, and as the condition progresses, hemorrhoid tissue may protrude during defecation. Early diagnosis and proper treatment are crucial since symptoms vary by stage.
- Rectal Bleeding
- The most common symptom of internal hemorrhoids is bright red bleeding during or after defecation. Usually painless, this bleeding can appear on toilet paper, on the surface of stool, or in the toilet bowl.
- Feeling of Fullness or Pressure in the Anus
- As internal hemorrhoids progress, patients may experience a sense of fullness, pressure, or incomplete evacuation. This sensation is especially common in second and third-degree hemorrhoids.
- Discomfort During Defecation
- Although internal hemorrhoids are typically painless, straining during bowel movements can cause the hemorrhoidal tissue to move in or out, causing discomfort. This is more noticeable in third and fourth-degree cases.
- Mucus Discharge and Itching
- Prolapsed internal hemorrhoids may secrete mucus, causing moisture around the anus and leading to itching. This symptom is common in chronic cases.
- Hemorrhoidal Prolapse
- In advanced stages, swollen hemorrhoidal veins may protrude outside the anus during defecation. Initially, they may retract on their own, but in later stages, manual reduction may be required.
Grading of Symptoms
| Grade | Definition | Symptoms |
|---|---|---|
| 1st | Only bleeding | Painless, bright red bleeding |
| 2nd | Protrudes during bowel movements, retracts spontaneously | Bleeding, fullness sensation |
| 3rd | Protrudes during bowel movements, requires manual reduction | Itching, discomfort, prolapse |
| 4th | Permanently prolapsed and cannot be manually reduced | Persistent prolapse, discharge, significant discomfort |
Treatment of Internal Hemorrhoids
Treatment depends on the stage of internal hemorrhoids, severity of symptoms, and impact on the patient’s quality of life. There are three main approaches: lifestyle modifications, medical treatments, and interventional methods.
- Lifestyle and Dietary Adjustments
- In early and moderate stages, managing constipation helps control symptoms:
- Consume fiber-rich foods (vegetables, fruits, whole grains)
- Drink at least 2–2.5 liters of water daily
- Develop healthier toilet habits (avoid straining)
- Avoid prolonged sitting and sedentary lifestyle
- In early and moderate stages, managing constipation helps control symptoms:
- Medical Treatment
- Topical creams and suppositories: Used to relieve symptoms; corticosteroid-based products should be used short-term.
- Phlebotonic medications: Improve venous tone and may alleviate hemorrhoidal symptoms.
- Interventional Methods
- For advanced internal hemorrhoids, the following procedures may be necessary:
- Typically used for 2nd and 3rd-degree hemorrhoids. A rubber band is placed at the hemorrhoid’s base, cutting off blood flow. The tissue falls off within 7–10 days.
- Injection of a chemical agent into hemorrhoidal tissue shrinks the veins. Effective for 1st and 2nd-degree hemorrhoids.
- Uses heat energy to shrink hemorrhoidal vessels. Effective for controlling bleeding.
- Surgical removal of hemorrhoids. Typically performed for 3rd and 4th-degree hemorrhoids, especially in the presence of prolapse.
- Detects and ties off hemorrhoidal arteries. A minimally invasive method with a shorter recovery time.
Which Department Should You Consult?
If internal hemorrhoids are suspected, patients should consult the General Surgery department. Surgeons with expertise in proctology are specialized in diagnosing and treating anorectal conditions.
Diagnostic Procedures by a General Surgery Doctor
- Digital rectal examination (physical exam)
- Anoscopy (using a lighted instrument to examine the anal canal)
- Proctoscopy (detailed internal examination)
These procedures help determine the stage of hemorrhoids, the extent of prolapse, and identify other potential rectal conditions.
When Are Internal Hemorrhoids Dangerous?
Although generally benign, certain circumstances warrant careful evaluation:
- Patients over 40 experiencing bleeding for the first time: A thorough workup is essential to rule out colorectal cancer.
- Severe and recurrent bleeding: May lead to anemia.
- Permanently prolapsed hemorrhoids: Risk of infection, necrosis, or strangulation.
- Sudden painful swelling: Could indicate a thrombosed hemorrhoid.
Internal hemorrhoids are often silent in the early stages but can impact quality of life as they progress. Early detection allows for effective management with medical treatments and lifestyle changes. In later stages, minimally invasive procedures or surgery may be necessary. Consulting a General Surgery specialist at the first sign is the best approach.
Disclaimer: All content is for informational purposes only and based on scientific sources valid at the time of preparation. For any symptoms, diagnosis, or treatment requirement, please contact your physician or a qualified healthcare provider.
