Internal Hemorrhoids: Symptoms, Treatment, and Management

Issues related to internal hemorrhoids?

Hello, Dr.
Ke! I would like to consult you regarding an issue with internal hemorrhoids.
(I apologize for the lengthy description, as I am quite confused and troubled.
Thank you in advance for your response.) For the past six months, I have experienced intermittent pain in the anal area during bowel movements, occurring about once or twice a month.
Each episode can last from two to five days (I have regular bowel habits and rarely experience constipation, though I occasionally have diarrhea).
However, once this issue arises, I tend to feel mild pain during bowel movements for the next two to five days.
The pain usually lasts only a few minutes after defecation, but occasionally I feel a slight discomfort in the anal area throughout the day.

Two weeks ago, I visited a large hospital for an examination.
The doctor performed a digital rectal exam and a sigmoidoscopy, indicating that I have mild internal hemorrhoids with some abrasions on them.
The doctor suggested that my pain likely stems from these abrasions.
He prescribed a topical ointment for hemorrhoids, but since he mentioned the location of the abrasions, I need to use my finger to apply the ointment one to two finger joints deep to reach the affected area.
I feel somewhat anxious about applying the medication.

Yesterday, I experienced mild discomfort during a bowel movement, and I attempted to apply the ointment for the first time in the evening.
While inserting it, I didn't feel much pain, but after a few minutes, I experienced significant pain and irritation, along with some bleeding at the anal opening.
For the next couple of hours, the pain was so intense that it made it difficult to sleep.
The following morning, I felt somewhat better, and the pain during bowel movements was only very mild.
However, during the day, I still felt slight swelling and discomfort at the anal area, which was more pronounced than when I did not apply the ointment.

I would like to ask if the abnormal pain I experienced after applying the ointment is a normal side effect of the medication.
The pain after applying the ointment was actually much worse than the pain I usually feel after a bowel movement, and the bleeding was also more noticeable than the occasional minor bleeding during defecation.
Should I continue using the ointment under these circumstances?
Additionally, I would like to inquire about my dietary habits.
I generally eat a light diet, consume plenty of fruits and vegetables, and drink a lot of water.
My bowel habits are regular, typically occurring after breakfast each day.
When I experience discomfort in the anal area, my bowel movements are usually not particularly hard or accompanied by diarrhea.
Therefore, I have been unable to understand what factors might be causing this issue.
Are there any other improvements I can consider? Currently, the discomfort usually resolves completely within three to five days, but it has recurred several times over the past six months.
Can this issue be improved through daily habits? I apologize for the lengthy description, and I greatly appreciate your response.

Niming, 30~39 year old female. Ask Date: 2016/08/20

Dr. Ke Fangxu reply Surgery

It is generally not recommended to insert fingers too deeply when using hemorrhoid ointments to avoid accidental rectal injury.
If applying the ointment is not very convenient, suppositories are also a practical option.
To improve bowel habits, in addition to the intake of fiber and water, gut bacteria are also an important element.
Besides commercially available probiotics, yogurt is also a good choice.

Reply Date: 2016/08/20

More Info

Internal hemorrhoids are a common condition that can cause discomfort and pain, particularly during bowel movements. Understanding the symptoms, treatment options, and management strategies is essential for effective care.

Symptoms of Internal Hemorrhoids
Internal hemorrhoids typically present with the following symptoms:
1. Painless Bleeding: One of the most common signs is bright red blood on the toilet paper or in the toilet bowl after a bowel movement. This bleeding is usually painless.

2. Discomfort or Pain: While internal hemorrhoids are generally painless, they can become painful if they prolapse (protrude outside the anal canal) or if there are associated fissures or irritation.

3. Itching or Irritation: Patients may experience itching or irritation around the anal area, which can be exacerbated by hygiene products or excessive wiping.

4. Mucus Discharge: Some individuals may notice a mucus discharge, which can contribute to irritation.

Treatment Options
The treatment for internal hemorrhoids can vary based on the severity of the symptoms. Here are some common approaches:
1. Lifestyle Modifications:
- Diet: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements. Staying well-hydrated is also crucial.

- Regular Exercise: Engaging in regular physical activity can promote bowel regularity and reduce the risk of constipation.

2. Topical Treatments:
- Over-the-counter creams and ointments, such as hydrocortisone or witch hazel, can help reduce inflammation and relieve itching. However, as you experienced, some topical treatments may cause irritation or discomfort, especially if applied too deeply or if there are existing fissures.

3. Sitz Baths: Soaking in warm water for 10-15 minutes several times a day can help soothe the anal area and reduce discomfort.

4. Medical Procedures: If conservative measures fail, medical interventions may be necessary. These can include:
- Rubber Band Ligation: A procedure where a rubber band is placed around the base of the hemorrhoid to cut off blood supply, causing it to shrink.

- Sclerotherapy: Involves injecting a solution into the hemorrhoid to shrink it.

- Infrared Coagulation: A technique that uses infrared light to coagulate the tissue and reduce hemorrhoid size.

- Surgical Options: In severe cases, surgical removal of hemorrhoids (hemorrhoidectomy) may be considered.

Management and Prevention
To manage and prevent the recurrence of internal hemorrhoids, consider the following:
- Avoid Straining: Straining during bowel movements can exacerbate hemorrhoids. If you feel the urge to go, don’t delay.

- Regular Bowel Habits: Establishing a routine can help maintain regularity and prevent constipation.

- Hygiene: Keep the anal area clean and dry. Use gentle wipes or water to clean after bowel movements, avoiding harsh soaps or excessive wiping.

- Monitor Symptoms: Keep track of any changes in symptoms, such as increased pain or bleeding, and consult a healthcare provider if symptoms worsen.

Conclusion
Your experience with the topical medication and subsequent pain is not uncommon, especially if there are existing irritations or fissures. It is essential to communicate with your healthcare provider about your symptoms and any side effects you experience from treatments. They may adjust your treatment plan or suggest alternative therapies to alleviate your discomfort.

In summary, while internal hemorrhoids can be bothersome, they are manageable with appropriate lifestyle changes, topical treatments, and medical interventions when necessary. If symptoms persist or worsen, seeking further evaluation from a specialist may be beneficial to rule out other conditions and ensure effective treatment.

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