Internal Hemorrhoids: Causes, Symptoms, and Treatment Options

Internal hemorrhoid bleeding

Hello, Dr.
Ko.
A while ago, I noticed blood on the surface of my stool, so I underwent a colonoscopy.
The results showed that I have internal hemorrhoids, and the doctor prescribed some ointments and medications for me to take and apply.
About a month later, I again found blood on the surface of my stool.
I read online that blood from internal hemorrhoids typically does not mix with the stool or stick to its surface.
However, in my case, it is sticking to the middle part of the surface.
Could this indicate another condition? Additionally, what can be done about bleeding from internal hemorrhoids? I went a week without blood, but then the following week, there was blood again, which is quite concerning for me.
I would appreciate your guidance.
Thank you.

Huang, 20~29 year old female. Ask Date: 2020/08/18

Dr. Ke Fangxu reply Surgery

This situation likely indicates mild hemorrhoidal bleeding.
As long as there is no further bleeding, it should not be a concern.
It is recommended to avoid constipation during this period and to shorten the time spent on the toilet.
Increasing dietary fiber intake can also be beneficial.
Warm sitz baths may help alleviate symptoms, and you can purchase hemorrhoidal suppositories at the pharmacy.
It is best not to take stool softeners indiscriminately.
If bleeding persists, it is important to consult a physician for evaluation and possible medication.
Since a colonoscopy has already been performed, there is no need for excessive worry.

Reply Date: 2020/08/18

More Info

Internal hemorrhoids, also known as piles, are swollen veins in the lower rectum and anus that can cause discomfort and bleeding. Understanding the causes, symptoms, and treatment options for internal hemorrhoids is essential for managing this condition effectively.

Causes of Internal Hemorrhoids
Internal hemorrhoids are primarily caused by increased pressure in the rectal area. This pressure can result from various factors, including:
1. Straining during bowel movements: This is often due to constipation or hard stools, which can lead to increased pressure on the veins in the rectum.

2. Chronic diarrhea: Frequent bowel movements can irritate the rectal area and lead to hemorrhoids.

3. Pregnancy: The increased weight of the fetus and hormonal changes can put pressure on the pelvic veins.

4. Obesity: Excess weight can increase pressure on the rectal veins.

5. Sedentary lifestyle: Lack of physical activity can contribute to constipation and increased pressure on the rectal area.

6. Aging: As people age, the tissues supporting the veins in the rectum can weaken.

Symptoms of Internal Hemorrhoids
The symptoms of internal hemorrhoids can vary, but common signs include:
- Painless rectal bleeding: This is often the most noticeable symptom. Blood may appear bright red and can be seen on the toilet paper, in the toilet bowl, or on the surface of the stool.

- Prolapse: In some cases, internal hemorrhoids can protrude outside the anus, becoming external hemorrhoids, which can be painful.

- Discomfort or itching: While internal hemorrhoids are usually painless, they can cause discomfort or itching in the anal area.

Treatment Options for Internal Hemorrhoids
Treatment for internal hemorrhoids can range from conservative home remedies to medical procedures, depending on the severity of the condition. Here are some common treatment options:
1. Dietary changes: Increasing fiber intake through fruits, vegetables, and whole grains can help soften stools and reduce straining during bowel movements. Staying hydrated is also crucial.

2. Over-the-counter medications: Topical treatments, such as creams or ointments containing hydrocortisone, can help relieve itching and discomfort. Oral pain relievers may also be used.

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

4. Minimally invasive procedures: If conservative treatments are ineffective, procedures such as rubber band ligation, sclerotherapy, or infrared coagulation may be recommended. These methods aim to reduce blood flow to the hemorrhoid, causing it to shrink.

5. Surgery: In severe cases, surgical options such as hemorrhoidectomy (removal of hemorrhoids) may be necessary.

Addressing Your Concerns
Regarding your specific situation, it is essential to note that while the presence of blood on the surface of your stool can indicate internal hemorrhoids, it is crucial to monitor the situation closely. If the bleeding persists or worsens, or if you experience additional symptoms such as pain, changes in bowel habits, or significant discomfort, it is advisable to consult your healthcare provider for further evaluation.

The intermittent nature of your symptoms—having a week without blood followed by another week with blood—can be typical for hemorrhoids, especially if there are fluctuations in bowel habits or dietary changes. However, it is also essential to rule out other potential causes of rectal bleeding, such as anal fissures, diverticular disease, or even more serious conditions like colorectal cancer.

In conclusion, while internal hemorrhoids are a common condition that can often be managed with lifestyle changes and conservative treatments, ongoing symptoms should be discussed with a healthcare professional to ensure appropriate management and to rule out other potential issues. Regular follow-ups and open communication with your doctor will help you navigate this condition effectively.

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