Internal Hemorrhoids: Causes, Treatments, and Recovery

Internal hemorrhoid bleeding

Hello, Dr.
Ke.
Last Friday, December 8th, my husband (36 years old) went to the outpatient clinic due to blood in his stool.
After an examination, it was determined that he had bleeding internal hemorrhoids, and the doctor performed a ligation procedure at that time, along with prescribing hemorrhoid ointment.
After leaving the hospital, we went out for dinner, and while settling the bill, my husband suddenly experienced significant bleeding and was urgently taken to the hospital.
The emergency department assessed that he had a ruptured internal hemorrhoid and performed emergency surgery to remove the ruptured hemorrhoid and another larger hemorrhoid.
My husband has since been discharged and is resting at home, with his bowel function restored.

I noticed from previous inquiries that ligation of internal hemorrhoids is a common procedure, so why did my husband experience such heavy bleeding? If he hadn't undergone a colonoscopy, would he have remained unaware of his internal hemorrhoids? If so, wouldn't that be like having a ticking time bomb in his body? The doctor has already removed the affected internal hemorrhoid, so why weren't the others also removed? Yesterday, I looked at the wound and felt it resembled a polyp; is this normal? The medications prescribed by the doctor only relieve symptoms; if the wound has healed, does he still need to apply the hemorrhoid ointment? Thank you for taking the time to respond.
Thank you.

yul, 30~39 year old female. Ask Date: 2017/12/12

Dr. Ke Fangxu reply Surgery

Rubber band ligation for internal hemorrhoids is indeed a commonly used procedure; however, any intervention may have associated complications.
A minority of patients may experience pain and bleeding.
There are many causes of hematochezia, and a colonoscopy is necessary to obtain a definitive diagnosis.
However, not all hemorrhoidal tissue will experience significant bleeding, so it is not accurate to say that everyone has a ticking time bomb, nor is there a need for prophylactic excision.
I do not understand what your husband had excised and what was left behind, but it is appropriate to treat the bleeding point in the case of an emergency.
Temporary swelling of the wound is also normal.
It is reasonable for the doctor to prescribe medication to alleviate symptoms.
If the wound heals without further pain or bleeding, there may be no need to continue applying ointment.

Reply Date: 2017/12/12

More Info

Internal hemorrhoids are a common condition that can lead to significant discomfort and complications if not managed properly. Understanding the causes, treatments, and recovery process is essential for anyone dealing with this issue.

Causes of Internal Hemorrhoids
Internal hemorrhoids occur when the veins inside the rectum become swollen and inflamed. Several factors can contribute to this condition, including:
1. Straining during bowel movements: This is often due to constipation or diarrhea, which can increase pressure on the rectal veins.

2. Prolonged sitting: Spending long periods sitting, especially on the toilet, can exacerbate the condition.

3. Obesity: Excess weight can put additional pressure on the pelvic veins.

4. Pregnancy: The increased pressure from the growing uterus can lead to hemorrhoids.

5. Age: As people age, the tissues supporting the veins in the rectum can weaken.

Treatments for Internal Hemorrhoids
Treatment options for internal hemorrhoids vary depending on the severity of the condition. Common treatments include:
1. Conservative measures: These include dietary changes (increasing fiber intake), hydration, and over-the-counter medications to alleviate symptoms.

2. Minimally invasive procedures: Rubber band ligation, as performed on your husband, is a common method where a band is placed around the base of the hemorrhoid to cut off blood supply, causing it to shrink and fall off.

3. Surgical options: If conservative treatments fail or if there are complications, surgical removal of hemorrhoids (hemorrhoidectomy) may be necessary.

In your husband's case, the emergency situation following the rubber band ligation indicates a possible complication, such as a rupture of the hemorrhoid or excessive bleeding. This can happen if the hemorrhoid is particularly large or if there is an underlying issue that was not addressed prior to the procedure.

Recovery and Follow-Up Care
Recovery from hemorrhoid surgery typically involves:
1. Pain management: Over-the-counter pain relievers or prescribed medications can help manage discomfort.

2. Wound care: Keeping the area clean and applying any prescribed ointments as directed is crucial for healing.

3. Dietary adjustments: Continuing to consume a high-fiber diet and staying hydrated can prevent constipation and reduce strain during bowel movements.

Regarding your concerns about the presence of other hemorrhoids, it is common for patients to have multiple hemorrhoids, and the decision to remove them during surgery depends on various factors, including their size, symptoms, and the surgeon's assessment. If your husband has been advised to use hemorrhoid cream, it is typically to help with symptom relief, especially if there is still irritation or discomfort.

Conclusion
While the situation your husband experienced is unfortunate, it is not uncommon for complications to arise from procedures like rubber band ligation. Regular follow-ups with the healthcare provider are essential to monitor recovery and address any new symptoms, such as the feeling of a polyp-like growth at the surgical site. If there are ongoing concerns about the healing process or the presence of additional hemorrhoids, a follow-up examination or consultation with a specialist may be warranted.

In summary, internal hemorrhoids can be effectively managed with a combination of lifestyle changes, medical treatments, and surgical interventions when necessary. Understanding the condition and maintaining open communication with healthcare providers can significantly improve outcomes and quality of life.

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