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

58sec

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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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Written by Yu Xu Chao

Colorectal Surgery

1min 18sec

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How to solve internal hemorrhoids that are prolapsed and incarcerated?

In clinical practice, for cases where internal hemorrhoids prolapse and become incarcerated, surgical treatment is often recommended. This is because the prolapse of internal hemorrhoids indicates a significant displacement and that the hemorrhoids have been prolapsed for a long time, which can lead to incarceration. In such cases, there is a risk of localized swelling or thrombosis formation, causing anal swelling and pain, and in severe cases, necrosis of the prolapsed tissue. Therefore, it is advised to opt for surgical treatment as soon as possible for incarcerated internal hemorrhoidal prolapse. Surgical options include hemorrhoidal banding, PPH (Procedure for Prolapse and Hemorrhoids), and TST (Transanal hemorrhoidal dearterialization) among others. Anesthetic choices can range from local infiltration anesthesia, spinal anesthesia, to general intravenous anesthesia. With spinal and general anesthesia, the patient does not experience pain during surgery and does not feel fear of pain. Post-surgery, it is also necessary to select appropriate medications for dressing changes, such as anal washes, hemorrhoidal suppositories, and golden yellow ointment to promote wound healing.

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Written by Deng Heng

Colorectal Surgery

54sec

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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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Written by Yu Xu Chao

Colorectal Surgery

1min 18sec

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Can internal hemorrhoids that prolapse be treated conservatively without surgery?

If internal hemorrhoids can be manually reduced after prolapse, then surgery can be temporarily avoided, and conservative treatment can be administered. For example, the patient should ensure smooth defecation, perform anal lifting exercises after defecation, strengthen the anal sphincter, and prevent the recurrence of internal hemorrhoids. Additionally, the duration of defecation should not be too long, and excessive straining should be avoided to prevent worsening of the prolapsed hemorrhoids. Moreover, patients must pay attention to the hygiene around the anus, and cleanse the peri-anal area with warm saline water after each bowel movement. However, if the internal hemorrhoids cannot be manually reduced after prolapse, or if incarceration and swelling occur, causing anal distension and pain, it is necessary to visit the hospital's colorectal surgery department promptly to undergo internal hemorrhoid ligation, TST, PPH, or other surgical procedures, followed by dressing changes. Since unresolved internal hemorrhoid prolapse can easily lead to incarceration or even necrosis, it is crucial to arrange for surgery as soon as possible, and patients should develop good bowel habits to maintain smooth defecation.

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Written by Deng Heng

Colorectal Surgery

21sec

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Will internal hemorrhoids affect menstruation?

Internal hemorrhoid bleeding can potentially affect menstruation. Although brief internal hemorrhoid bleeding does not affect menstruation, if the hemorrhoid bleeding is heavy, prolonged, frequent, and occurs daily or frequently, exceeding the body's ability to replace the lost blood, it can cause severe systemic anemia. In such cases, it might affect menstruation.