Do internal hemorrhoids require surgery?

Written by Chen Tian Jing
Colorectal Surgery
Updated on February 04, 2025
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The clinical symptoms of internal hemorrhoids are numerous, and surgery is only recommended if the internal hemorrhoids frequently recur, or if the clinical symptoms are severe. Severe internal hemorrhoids are primarily characterized by substantial rectal bleeding or recurrent prolapses, and due to repeated prolapses, friction on the local mucosa may even cause anal pain. A severe symptom of prolapsed internal hemorrhoids is that after each prolapse, the patient needs to manually reposition them, accompanied by jet-like or dripping fresh red rectal bleeding. Surgical methods for internal hemorrhoids mainly include hemorrhoidectomy with ligation or local injection of sclerosing agents.

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Written by Chen Tian Jing
Colorectal Surgery
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Do internal hemorrhoids need treatment?

Internal hemorrhoids require active treatment. If not actively treated, internal hemorrhoids may prolapse and worsen, or bleeding may intensify. This can lead to severe local symptoms and potentially develop from early-stage symptoms that are mild, into more severe cases that may only be significantly improved through surgery. The treatment methods for internal hemorrhoids primarily involve the use of topical and oral medications. When prolapse or severe swelling occurs, patients can take oral medications that clear heat, cool the blood, reduce swelling, and alleviate pain, specifically for hemorrhoids. These should be combined with local anal suppositories for symptomatic treatment. For cases accompanied by bleeding, oral hemostatic medications can be administered. If the prolapse is substantial, or if the internal hemorrhoids cannot retract back into the anus, surgical removal is recommended. (The use of medications should be under the guidance of a doctor.)

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Written by Chen Tian Jing
Colorectal Surgery
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How is internal hemorrhoids treated? Is there a way?

There are many treatment methods for internal hemorrhoids, the most common being medication. If the internal hemorrhoids repeatedly prolapse or bleed significantly, direct surgical removal can also be considered. Conservative treatments primarily involve the local use of hemorrhoid suppositories, combined with oral hemostatic and anti-swelling traditional Chinese medicine. If surgical criteria are met, direct surgical removal can be performed. Surgical methods mainly include injection of sclerosing agents into the mucosa of internal hemorrhoids, internal hemorrhoid banding, and internal hemorrhoid ligation and excision. To prevent recurrence after surgery, patients should maintain good dietary and bowel habits postoperatively, avoid overly spicy and stimulating foods, and try to keep bowel movements under ten minutes without straining excessively.

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Colorectal Surgery
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The Difference between Mixed Hemorrhoids and Internal Hemorrhoids

Mixed hemorrhoids and internal hemorrhoids are both clinical types of hemorrhoids. Generally speaking, mixed hemorrhoids mainly occur simultaneously with both internal and external hemorrhoids, while internal hemorrhoids are mainly local mucosal bulges near the dentate line in the anal canal. Both mixed and internal hemorrhoids belong to hemorrhoids, so there are many similarities in treatment. However, since mixed hemorrhoids generally involve both internal and external hemorrhoids acting together, they are generally more severe than internal hemorrhoids alone. Treatment for both mixed and internal hemorrhoids can involve conservative medication, primarily focusing on topical applications; for mixed hemorrhoids, local anal suppositories and hemorrhoidal ointment applications are commonly used, while treatment for internal hemorrhoids primarily involves hemorrhoidal suppositories. If both mixed and internal hemorrhoids meet certain surgical criteria, surgical treatment can be chosen. The surgical approach for mixed hemorrhoids mainly includes excision and ligation, while the surgical approach for internal hemorrhoids mainly involves hemorrhoid ligation or hemorrhoid banding. (Note: This answer is for reference only, use medication under the guidance of a professional physician, do not self-medicate.)

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Colorectal Surgery
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Will internal hemorrhoids be painful?

If internal hemorrhoids experience local mucosal rupture or repeated prolapse leading to friction of the mucosa, it is likely to cause pain and even bleeding. To avoid pain caused by internal hemorrhoids, it is recommended that patients use hemorrhoid suppositories for local administration in the rectum for early flare-ups to reduce swelling, relieve pain, and cool and stop bleeding. If internal hemorrhoids prolapse and cannot retract back into the anal canal on their own after each prolapse, it is suggested that patients consider surgery to ligate and excise the affected internal hemorrhoids, or inject sclerosants under the mucosa of the hemorrhoids to cause local mucosal consolidation and shedding. Patients with internal hemorrhoids are advised not to strain excessively during bowel movements to avoid worsening local congestion and edema.

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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.