Internal Hemorrhoids: Symptoms, Treatments, and Concerns

Symptoms of internal hemorrhoids?

Hello Dr.
Ke, I am the person who asked question #145510.
Thank you for your previous explanation.
I have been experiencing symptoms such as swelling, heaviness, blockage, soreness, a feeling of urgency, and dull pain in my rectal area, which have been alternating in intensity for over three months.
During this time, I have visited numerous hospitals and consulted with specialists in colorectal surgery, urology, and orthopedics.
I have undergone various examinations including digital rectal exams, X-rays, anoscopy, sigmoidoscopy, colonoscopy, CT scans, and PSA tests.
Some doctors have suggested conditions such as hemorrhoids, irritable bowel syndrome, chronic prostatitis, or autonomic nervous system disorders, but the treatments have only involved medications or topical applications, and the symptoms have not been effectively managed.
Recently, I also consulted a psychiatrist to prevent developing anxiety.
Three weeks ago, I had another examination at a medical center's colorectal surgery department, where the doctor diagnosed me with internal hemorrhoids and immediately performed a band ligation on one.
I experienced about a week of bleeding, but I felt much better and different from before.
Last week, I underwent a second band ligation, but the next day I noticed a rubber band in my stool.
On the third day after the ligation, the feelings of heaviness, soreness, and urgency returned to my rectal area.
Taking acetaminophen and applying ointments have not been very effective, although I feel somewhat better today.
I apologize for the lengthy message, but I would like to ask Dr.
Ke a few questions:
1.
I used to have normal bowel movements once a day without any history of hemorrhoids or bleeding.
Can internal hemorrhoids that do not protrude outside the anus cause symptoms such as rectal swelling, heaviness, blockage, soreness, and dull pain? Are there similar cases? I found information on Google stating that internal hemorrhoids that do not protrude do not cause pain, only bleeding.

2.
Although the rubber band fell off prematurely, I feel a foreign body sensation in my anus when urinating.
Does this mean the treatment is ineffective?
3.
Is there a high chance of recurrence after band ligation, and can surgical excision provide a permanent cure? Which type of surgery has fewer complications?
I would greatly appreciate your response.
Thank you!

Lin Xiansheng, 40~49 year old female. Ask Date: 2019/06/18

Dr. Ke Fangxu reply Surgery

1.
Theoretically, internal hemorrhoids should not cause pain; however, if they are located near the dentate line, discomfort may occur.

2.
The effectiveness of treatment depends on whether symptoms improve; if symptoms improve, it can be considered a successful treatment.

3.
Ligation is not a curative treatment method, and surgical excision also carries a risk of recurrence.
In fact, completely removing hemorrhoidal tissue can lead to complications such as gas and liquid incontinence.
Personally, I do not recommend surgical treatment unless there is significant bleeding or severe prolapse.

Reply Date: 2019/06/18

More Info

Understanding internal hemorrhoids and their associated symptoms, treatments, and concerns is crucial for managing this common condition. Internal hemorrhoids are swollen veins located inside the rectum, and they can cause a variety of symptoms, even if they do not protrude outside the anus.
1. Symptoms of Internal Hemorrhoids: While it is commonly believed that internal hemorrhoids do not cause pain unless they protrude, this is not entirely accurate. Internal hemorrhoids can lead to discomfort, a feeling of fullness or pressure in the rectal area, and even dull pain. The symptoms you describe—such as a feeling of swelling, heaviness, and discomfort—can indeed be associated with internal hemorrhoids. In some cases, patients may experience sensations of blockage or a persistent urge to have a bowel movement, which can be distressing. It is not uncommon for individuals with internal hemorrhoids to report symptoms that fluctuate in intensity, as you have experienced.

2. Treatment and Effectiveness: The treatment for internal hemorrhoids often includes conservative measures such as dietary changes, increased fiber intake, and topical treatments. Rubber band ligation, which you underwent, is a common procedure for treating symptomatic internal hemorrhoids. The fact that you experienced a rubber band falling out could indicate that the ligation was not entirely successful, or that the hemorrhoid was not sufficiently secured. However, the sensation of having a foreign body in the rectal area after such a procedure can be common and may not necessarily indicate treatment failure. If the discomfort persists or worsens, it is essential to follow up with your healthcare provider for further evaluation.

3. Recurrence and Surgical Options: Recurrence of hemorrhoids after rubber band ligation is possible, especially if underlying factors such as chronic constipation or straining during bowel movements are not addressed. Surgical options, such as hemorrhoidectomy, can provide a more permanent solution and are generally considered when other treatments fail. A hemorrhoidectomy involves the surgical removal of hemorrhoids and can be effective in preventing recurrence. However, it is associated with a longer recovery time and potential complications, such as pain and bleeding. Discussing the risks and benefits of each treatment option with your healthcare provider is essential to determine the best course of action for your specific situation.

In summary, internal hemorrhoids can indeed cause discomfort and other symptoms even if they do not protrude. Your experience with rubber band ligation is not uncommon, and while recurrence is possible, surgical options exist for more definitive treatment. It is crucial to maintain open communication with your healthcare provider to address your symptoms and concerns effectively.

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