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 Yu Xu Chao
Colorectal Surgery
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Can warm water sitz baths improve internal hemorrhoids that have prolapsed?

Warm sitz baths for prolapsed internal hemorrhoids can improve anal heaviness to some extent, and prevent inflammatory edema caused by the prolapse. They can also help prevent further worsening of prolapsed hemorrhoids, as warm sitz baths promote circulation around the anal area, relieve heaviness, and can somewhat reduce the prolapse, but they cannot completely cure it. Prolapsed internal hemorrhoids are caused by pathological hypertrophy and descent of the anal cushions, representing an organic lesion. Simple conservative medical treatment can only prevent the hemorrhoids from worsening, but cannot fully cure them. For prolapsed internal hemorrhoids that can be manually reduced, conservative treatment is generally recommended. Regular smooth bowel movements should be maintained, long duration of defecation should be avoided, and frequent anal sphincter exercises should be performed. However, for prolapsed hemorrhoids that cannot be reduced, or those that develop incarceration with edema or thrombosis, surgical treatment is recommended.

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Written by Chen Tian Jing
Colorectal Surgery
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What should I do if internal hemorrhoids have been bleeding for several days?

If internal hemorrhoids have been bleeding continuously for several days, and the bleeding is substantial, it is advisable to promptly undertake active hemostasis treatment. Common treatments for bleeding internal hemorrhoids mainly include taking oral hemostatic medication, or using suppositories and ointments for hemorrhoids to actively stop the bleeding. However, conservative treatment can only provide temporary relief of symptoms. If after treatment, the patient does not pay attention to a light diet or good bowel habits, there may also be a recurrence of hemorrhoid bleeding. If the bleeding is already severe, and there is a possibility of serious anemia, it is advised to perform a local internal hemorrhoid ligation surgery as soon as possible to prevent anemia or exacerbate the severity of the disease. (Medication should be used under the guidance of a doctor.)

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Written by Chen Tian Jing
Colorectal Surgery
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Can you drink alcohol if you have internal hemorrhoids bleeding?

If a patient experiences internal hemorrhoid bleeding, it is not advisable to drink alcohol during the bleeding period. Alcohol contains excessive amounts of irritating substances. Excessive drinking can cause excessive congestion of the mucous membrane of the internal hemorrhoids, and the already ruptured mucosa may increase the likelihood of further bleeding. Therefore, drinking alcohol during internal hemorrhoid bleeding can increase the amount of bleeding and might even lead to an increase in the size of the hemorrhoids, or the formation of acute edema and thrombosis, worsening the severity of the condition. During the bleeding period of internal hemorrhoids, patients are advised to follow a light diet and may need to further combine this with oral hemostatic medications, or use hemorrhoidal suppositories and hemorrhoid creams for symptomatic hemostasis and anti-swelling treatment. (The use of medications should be conducted under the guidance of a doctor.)

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Written by Yu Xu Chao
Colorectal Surgery
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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.

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Written by Deng Heng
Colorectal Surgery
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What should I do if internal hemorrhoids are bleeding?

The main symptoms of internal hemorrhoids are bleeding and protrusion, where the hemorrhoidal tissue prolapses outside the anus. There are several types of bleeding: the first is dripping blood during defecation, where blood drops steadily. Another type is spraying blood, similar to the way a syringe ejects fluid; these are all categorized under rectal bleeding. For internal hemorrhoids, the presence of either bleeding or prolapse outside the anus indicates a need for surgical treatment. This means that if internal hemorrhoids cause spraying blood, surgical treatment is required (i.e., removing the hemorrhoidal tissue), which can improve the bleeding and spraying issues.