What should I do if the internal hemorrhoids bleeding is very severe?

Written by Deng Heng
Colorectal Surgery
Updated on February 04, 2025
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Internal hemorrhoids bleeding, also known as rectal bleeding, is the main clinical manifestation in patients with internal hemorrhoids. In clinical practice, we often see a minority of patients with internal hemorrhoids experiencing long-term chronic bleeding, which can lead to severe anemia. In our clinical practice, the normal hemoglobin level in adults is 120g/L, but some patients are found to have hemoglobin levels of 30-40g/L upon consultation, indicating severe anemia. Therefore, these patients need to receive blood transfusions first, followed by surgical treatment.

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Written by Chen Tian Jing
Colorectal Surgery
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The difference between rectal prolapse and internal hemorrhoids prolapse

Rectal prolapse primarily refers to the prolapse of the rectal mucosa or part of the sigmoid colon mucosa, partially or completely falling out of the anus. Generally, there is a ring-shaped or cylindrical mucosa protrusion outside the anus. Internal hemorrhoid prolapse involves the partial prolapse of the mucosa near the dentate line, typically appearing as small lumps or accompanied by local venous thrombosis and varicose clusters, with rectal prolapse being more severe than internal hemorrhoid prolapse. The treatment of rectal prolapse mainly involves surgery, while early stages of internal hemorrhoid prolapse can be treated with medications. This involves using topical hemorrhoid creams or suppositories to alleviate symptoms. If there are recurrent prolapses or accompanying bleeding during bowel movements, surgical treatment may also be considered. Surgical methods for rectal prolapse primarily involve local mucosal ring excision, whereas surgeries for internal hemorrhoids mainly include hemorrhoid ligation or banding procedures.

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

Surgical indications for internal hemorrhoids include bleeding and prolapse of anal masses. These symptoms necessitate surgical treatment. Secondly, if scheduling surgery is not possible due to being busy, conservative treatment like applying ointment to the anus or taking medication can be used initially to alleviate the symptoms. If conservative treatment fails, it is still not too late to opt for surgery. (Specific medications should be used under the guidance of a physician.)

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Written by Deng Heng
Colorectal Surgery
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How is internal hemorrhoids bleeding caused?

Internal hemorrhoids bleeding is caused primarily by venous dilation and congestion. Anatomically speaking, hemorrhoids are varicose veins, which means they contain a lot of fresh blood. When straining during defecation, the hemorrhoids rub against the dry stool, causing the mucous membrane of the hemorrhoids to rupture and leading to bleeding symptoms. When the bleeding symptoms are mild, blood can be seen in the stool during defecation, or drops of blood may appear during bowel movements. In severe cases, spraying bleeding may occur. Generally, the bleeding stops after defecation.

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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 Chen Tian Jing
Colorectal Surgery
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How long does it take to recover from internal hemorrhoidectomy surgery?

The recovery time after internal hemorrhoidectomy mainly depends on the severity of the condition before the surgery. Most internal hemorrhoidectomies, specifically referring to internal hemorrhoid ligation surgeries combined with sclerotherapy injections, generally require a recovery period of about 2-3 weeks. If the internal hemorrhoids were significantly prolapsed before the surgery or if there were multiple prolapsed hemorrhoids, the recovery time might be relatively longer. If the procedure involved only localized ligation or sclerotherapy injections and there are no external wounds around the anus, the recovery time is approximately one week. During the recovery period, patients need to maintain a light diet, avoid dry stools and excessive straining during bowel movements, which could lead to pain or bleeding at the surgical site.