Is bleeding from hemorrhoids internal hemorrhoids?

Written by Ren Zheng Xin

Gastroenterology

Updated on September 25, 2024

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Hemorrhoids causing blood in the stool are mostly due to internal hemorrhoids, which are a manifestation of varicose veins in the hemorrhoidal veins. During defecation, because the stool is rather dry and hard, it can easily scratch the hemorrhoidal veins as it moves downward. Due to internal hemorrhoids, the hemorrhoidal veins become distended and the vein walls become very thin, making them easily damaged, thus leading to bleeding. Minor cases may involve blood during defecation or dripping blood, while more severe cases can present with spraying blood during bowel movements. Depending on the amount of bleeding, one should choose treatments such as medications, minimally invasive procedures, or surgery.

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Written by Chen Tian Jing

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Is the bleeding from internal hemorrhoids bright red?

The majority of internal hemorrhoid bleeding is bright red, but if there is a significant amount of bleeding, blood may accumulate within the anal canal and form clots, resulting in darker colored blood in the stool. To identify and diagnose whether it is bleeding from internal hemorrhoids, it is recommended that patients undergo an anoscopic examination. If obvious bleeding points are found near the mucosa around the dentate line, it is mostly due to internal hemorrhoids. To treat bleeding from internal hemorrhoids, it is first necessary to take oral or topical hemostatic medications for symptomatic treatment. If the internal hemorrhoid bleeding has been prolonged, or in cases of chronic blood loss, further surgical ligation may be necessary to stop the bleeding and prevent anemia due to excessive blood loss. (The use of medications should be under the guidance of a doctor.)

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Can internal hemorrhoids heal on their own?

To determine whether internal hemorrhoids bleeding is self-healing, one should primarily assess the amount of bleeding and the duration of bleeding to further evaluate the severity of the condition. If it is the first occurrence or if the bleeding is mostly noticeable on toilet paper and is relatively minor, self-healing of internal hemorrhoids bleeding can be achieved through lubrication of the stool during defecation and, if necessary, oral administration of cooling blood-stopping medications. However, if the bleeding duration is prolonged, or if the amount of bleeding is significant each time, it is unlikely to achieve complete healing simply through lifestyle adjustments, dietary changes, or even medication. Further surgical ligation and hemostasis treatment may be required for the patient.

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Colorectal Surgery

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Can I exercise more if I have internal hemorrhoids bleeding?

If the patient is in a period of internal hemorrhoids bleeding, it is not advised for the patient to engage in excessive exercise and physical training, as the local mucosa is ruptured and bleeding during this period. Excessive exercise can potentially increase the pressure inside the local blood vessels, thereby increasing the amount of bleeding or worsening the condition. During internal hemorrhoids bleeding, related hemostatic treatments are necessary to prevent anemia from long-term repeated bleeding. Treatment mainly involves oral or topical hemostatic drugs. In terms of exercise and training, it is recommended to primarily walk gently and avoid vigorous exercises. If conservative medication does not effectively treat the bleeding, surgical ligation can also be considered for hemostasis. (Please use medications under the guidance of a doctor.)

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Written by Deng Heng

Colorectal Surgery

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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.

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The difference between rectal polyps and internal hemorrhoids

Rectal polyps are skin-like mucosal protrusions that grow on the rectal mucosa, whereas internal hemorrhoids are confined to congestion and protrusion of the mucosa around the dentate line. The formation of rectal polyps is mainly due to long-term stimulation by feces, or certain constitutional and genetic factors, while the most likely cause of internal hemorrhoids is chronic congestion and edema around the anal area or the formation of venous thrombosis, leading to local varicose clusters. After the discovery of rectal polyps, it is necessary to perform surgery as soon as possible; however, the treatment for internal hemorrhoids in the early stages is primarily conservative, aimed at delaying the frequency of disease attacks and improving the quality of life for the patient. If the internal hemorrhoids reach a later stage or become severe, manifested by recurrent prolapse and rectal bleeding, surgical removal is recommended.