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 Deng Heng
Colorectal Surgery
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Symptoms of internal hemorrhoids outbreak

Symptoms of internal hemorrhoids: Internal hemorrhoids refer to the venous clusters located above the dentate line at the end of the rectum, which are branches of the superior rectal vein. The main symptoms of internal hemorrhoids include the following: The first is rectal bleeding, which is generally bright red in color and usually not accompanied by pain. The bleeding can be in droplets or in a spraying manner; the second is the prolapse of the hemorrhoidal nucleus, which can protrude outside the anus during bowel movements; the third is that once the hemorrhoidal nucleus has prolapsed outside the anus, symptoms such as moisture and itching around the anus may occur.

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Written by Deng Heng
Colorectal Surgery
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Do internal hemorrhoids always require surgery?

The prolapse of hemorrhoidal nodules is the main symptom of internal hemorrhoids progressing to the middle and late stages. In the middle stage, the hemorrhoidal nodules prolapse during defecation but can be spontaneously reduced afterwards. In the late stage, internal hemorrhoids require manual reduction or a period of bed rest after defecation, and may even prolapse during normal activities, walking, exhaustion, as well as during coughing, sneezing, or squatting. Some patients cannot manually reduce the prolapsed nodules back into the anus, making them highly susceptible to infection. Due to inflammation, edema, and pain, incarceration occurs, making reduction difficult. Therefore, the prolapse of internal hemorrhoids is a symptom of the middle to late stages of hemorrhoids, and surgery is definitely needed.

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Written by He Cai Dong
Colorectal Surgery Department
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How to determine if there are internal hemorrhoids when experiencing fresh blood in stool?

Fresh blood in the stool is usually caused by internal hemorrhoids. Bleeding from internal hemorrhoids can be seen on toilet paper, fresh blood in the toilet bowl, and sometimes severe bleeding can be spray-like. Based on the color of the blood, we can generally determine it to be internal hemorrhoids. When internal hemorrhoids are severe, anal lumps may protrude after defecation. If minor, the lumps can retract on their own; if severe, they need to be manually pushed back in, and if more severe, they remain irreducible at the anus. If you notice any of these symptoms, it is recommended that you visit the hospital's proctology department. A doctor can confirm whether the bleeding is caused by internal hemorrhoids through a digital rectal examination and an anoscopy, and then prescribe appropriate treatment.

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Written by Deng Heng
Colorectal Surgery
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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.

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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.