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Internal hemorrhoids
"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.
Is bleeding from internal hemorrhoids serious?
Bleeding from internal hemorrhoids, also known as rectal bleeding, is a common primary symptom in patients with internal hemorrhoids. Although the bleeding from internal hemorrhoids is painless and not itchy, it occurs during bowel movements and can be either a trickle or a spray of blood. Although the amount of bleeding might not be large and may subside naturally, in clinical practice, we have seen a minority of patients with long-term chronic bleeding leading to severe anemia. For example, the normal hemoglobin level in adults should be 120g/L, but at the time of consultation, their hemoglobin has dropped to 30, 40, or 50g/L. Treatment then requires an initial blood transfusion followed by surgery, which can be quite complicated. Therefore, bleeding from internal hemorrhoids should be taken seriously.
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.
Does pressing on an internal hemorrhoid cause pain?
If internal hemorrhoids prolapse and become incarcerated or a thrombus forms locally, pressing on the area will cause pain, especially when the patient is walking or sitting, making the pain more apparent. For such cases, which are considered a severe stage of internal hemorrhoids, it's advisable to undertake surgical treatment as soon as possible. Clinically, treatment options for internal hemorrhoids include procedures like rubber band ligation, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization), with continued dressing changes required post-surgery. However, if the prolapsed internal hemorrhoids can retract spontaneously or can be manually reduced, pressing on them generally does not cause pain because internal hemorrhoids are located above the dentate line in the anal canal, an area innervated by autonomic nerves, which are less sensitive to pain. In the absence of inflammation or thrombosis, pressing on the area will not typically cause pain. In such cases, patients should develop good bowel habits to prevent the further worsening of internal hemorrhoids.
The difference between internal and external hemorrhoids
Internal hemorrhoids are located above the dentate line in the anal canal, at the end of the rectum, and are innervated by the autonomic nervous system. Clinically, they are mainly characterized by intermittent, painless rectal bleeding. The blood is bright red, often dripping or spraying after defecation. If internal hemorrhoids worsen, they can prolapse and even become strangulated and edematous, causing anal swelling and pain. External hemorrhoids, on the other hand, are located below the dentate line in the anal canal, and are innervated by the spinal nerves, making them more sensitive to pain. Clinically, they are categorized into skin tag-type external hemorrhoids, varicose vein-type external hemorrhoids, inflammatory external hemorrhoids, and thrombotic external hemorrhoids. Skin tag-type and varicose vein-type external hemorrhoids primarily cause a sensation of a foreign body and itching in the anus, while inflammatory or thrombotic external hemorrhoids can lead to an increase in perianal secretions and anal swelling and pain, necessitating prompt surgical removal of the external hemorrhoids.
Can internal hemorrhoids burst by themselves?
Internal hemorrhoids that prolapse should not be burst forcibly. As internal hemorrhoids are located at the anus, they are continuously exposed to contaminants from fecal and secretion matter over time. If the prolapsed hemorrhoids burst, it could lead to local infections and even necrosis. Therefore, do not burst prolapsed hemorrhoids, but rather, try to push them back into the anus. If they cannot be reinserted, it is recommended to opt for surgical treatment early to avoid rupture or strangulated edema, which can lead to swelling, pain, or necrosis in the anal area. Surgical options include hemorrhoidal banding, PPH, or TST procedures. Post-surgery, treatments may include the use of anal washes, red ointment gauze, aureomycin ointment, etc. Moreover, patients should eat a light diet, maintain smooth bowel movements, and regularly perform pelvic floor exercises.
How many days will it take for internal hemorrhoids to heal after prolapse?
If a patient exhibits prolapsed internal hemorrhoids, it is first recommended that a professional proctologist reposition the prolapsed hemorrhoids. If prolapse continues to recur after repositioning, the likelihood of spontaneous recovery is low, and the patient will likely need further surgical treatment. Prolapse is a common clinical symptom of hemorrhoids. If it is a simple prolapse that can retract spontaneously, symptoms can be relieved within 3 to 5 days after medication treatment. However, if the prolapse requires manual repositioning by the patient, or if it recurs repeatedly, surgical removal is necessary. Recovery from the surgery typically takes about 2 to 3 weeks.
How to stop bleeding from internal hemorrhoids prolapse?
If internal hemorrhoids bleeding leads to unstoppable bleeding, the most common and direct way to stop the bleeding primarily involves local ligation. The prolapse and bleeding of internal hemorrhoids are mainly due to the repeated prolapse and friction of the local mucosa causing rupture and bleeding, or the persistent bleeding from ruptured small arteries. If prompt hemostatic treatment is not administered, it could potentially lead to chronic blood loss and subsequent anemia due to decreased blood volume. Therefore, if patients experience bleeding from internal hemorrhoids, especially if the bleeding is prolonged or substantial, it is advised to visit a proctology department for relevant examinations soon. If necessary, it may be crucial to promptly proceed with internal hemorrhoidal ligation surgery.
Hemorrhoids: What dietary considerations should be noted?
Patients with internal hemorrhoids should primarily focus on a reasonable diet, paying attention to eat less or avoid spicy and stimulating foods and condiments. Additionally, they should cultivate the habit of drinking more water, preferably light salt water or honey water. For constipation and hemorrhoids, it's important to consciously drink more water and eat more fruits and fresh vegetables, especially those that are rich in coarse fiber. Stimulating foods such as chili peppers, black pepper, ginger, garlic, and onions should be consumed minimally.
Can internal hemorrhoids be treated with wet compresses?
After prolapse of internal hemorrhoids, moist compresses can be applied, but the therapeutic effect of moist compresses is not significant. The prolapse of internal hemorrhoids mainly occurs when the anal cushion pathologically enlarges and shifts downward, leading to the prolapse. If the prolapsed hemorrhoids cannot be retracted back into the anus, this can lead to incarcerated edema, causing swelling and pain around the anus. If the incarceration lasts too long, it can induce local thrombosis or even necrosis. In such cases, it is recommended to opt for surgical treatment as soon as possible. Common surgical methods include internal hemorrhoid ligation, internal hemorrhoid excision, PPH (Procedure for Prolapse and Hemorrhoids), or TST (Transanal Hemorrhoidal Dearterialization). After surgery, it is advisable to use anal washes or potassium permanganate solutions for sitz baths, and then apply topical treatments such as hemorrhoid creams, red oil gauze strips, and yellow ointments to promote postoperative recovery. Moreover, patients should develop good bowel habits after surgery to maintain smooth bowel movements, which further aids recovery. (Under the guidance of a doctor for medication use)