Internal Hemorrhoids: Treatment Options and Concerns

Issues Related to Internal Hemorrhoids and the Use of Ointments

Consulting a doctor: Previously, after using the restroom, I experienced a protrusion from my anus that would retract on its own.
After some time, I needed to push it back manually.
Last week, after having diarrhea for three days, I found that I couldn't push it back easily, and there was a lot of blood on the toilet paper, which scared me.
I asked my family, and they suggested it might be hemorrhoids, so I bought over-the-counter hemorrhoid cream and used it for a week, but it didn't seem to help much.
I then visited a doctor who diagnosed me with internal hemorrhoids and prescribed medication.
I have a few questions:
1.
How severe is my internal hemorrhoid, and do I need surgery? It feels like I can't push it back easily, and I need to wash my anus with water each time to slowly push it back, which is the only way I feel comfortable.
I'm worried that just wiping might cause bleeding.
2.
The over-the-counter cream I bought is Hemorrhoid Relief Cream (with ingredients per gram: Lidocaine 30mg, Hydrocortisone Acetate 25mg, Allantoin 5mg, Zinc Oxide 50mg).
The hospital prescribed me Le-Yu Hemorrhoid Ointment (with Lidocaine, Phenylephrine, Betamethasone).
The instructions say that because it contains steroids, it can thin the skin, so it is not recommended for use longer than a week.
Does this mean I can only use it for a week? I found online that Yi-Zhi-Kang does not contain steroids (Sodium oleate, Hydroxypolyethoxydodecane, Chlorocarvacrol).
Can this be used long-term? Is there a specific recommendation for which one to use?
3.
After applying the medication, I sometimes feel a cooling or warming sensation, and occasionally it hurts.
Is this normal?
4.
How long does it take for the medication to be effective? It feels like there is no reduction, and the protrusion after using the restroom still appears swollen.
5.
I noticed a bump on the internal hemorrhoid that feels like an acne pimple.
What could this be? Is it a wound? I remember the doctor used a rectoscope for examination but did not say anything.
Thank you for your response, doctor.

Niming, 40~49 year old female. Ask Date: 2024/01/11

Dr. Zhang Shuhao reply Surgery

1.
Prolapsed internal hemorrhoids that require manual reduction are classified as third-degree hemorrhoids.
Diarrhea can sometimes exacerbate hemorrhoid symptoms; if the hemorrhoids can spontaneously reduce without manual intervention, they are classified as second-degree.
The symptoms and frequency of hemorrhoid flare-ups vary among individuals, but if they affect quality of life, surgical intervention should be considered.
2.
The purpose of hemorrhoid ointments is to alleviate swelling and pain during flare-ups.
The addition of steroids can enhance the anti-inflammatory effects, but no ointment can eliminate hemorrhoids entirely.
Long-term use is not recommended, as even non-steroidal options may cause perianal skin irritation.
3.
It is normal to occasionally feel a cooling or warming sensation, and sometimes pain, after applying the ointment.
4.
While applying the ointment can relieve swelling and pain, the hemorrhoidal tissue will not disappear.
Additional warm sitz baths can help reduce swelling.
5.
If you feel a raised area on the internal hemorrhoid that resembles an acne bump, it is likely a hemorrhoidal thrombosis.
If there has been recent bleeding, it may appear reddish-black, which is a common manifestation of internal hemorrhoids; hence, the doctor may not have specifically mentioned it.

Reply Date: 2024/01/11

More Info

Understanding internal hemorrhoids is crucial for effective management and treatment. Internal hemorrhoids are swollen veins in the rectum that can cause discomfort, bleeding, and protrusion during bowel movements. They are classified into four grades based on their severity, which can help determine the appropriate treatment approach.

1. Grading of Internal Hemorrhoids:
- Grade I: Hemorrhoids that do not protrude outside the anal canal.

- Grade II: Hemorrhoids that protrude during bowel movements but retract spontaneously.

- Grade III: Hemorrhoids that protrude and require manual reduction.

- Grade IV: Hemorrhoids that are permanently prolapsed and cannot be pushed back in.

Given your description of the hemorrhoids that require manual reduction and are accompanied by bleeding, it is likely that you are dealing with Grade III or possibly Grade IV hemorrhoids. Surgical intervention may be necessary if conservative treatments fail or if the hemorrhoids are causing significant discomfort or complications.

2. Topical Treatments:
- The medications you mentioned, such as the over-the-counter hemorrhoid cream containing lidocaine, hydrocortisone, allantoin, and zinc oxide, are designed to relieve symptoms like pain and inflammation. However, prolonged use of corticosteroids (like hydrocortisone) can lead to skin thinning, which is why it's advised not to use them for more than a week without medical supervision.

- The prescription cream, which contains lidocaine, phenylephrine, and betamethasone, should also be used cautiously due to the potential side effects of steroids.

- The alternative product you found, which does not contain steroids, may be suitable for long-term use, but it’s always best to consult your healthcare provider for personalized advice.

3. Symptoms After Application:
- Experiencing a cooling or warming sensation after applying topical treatments can be normal, as these products often contain ingredients that can cause such sensations. However, if you experience significant pain or discomfort, it may be a sign of irritation or an allergic reaction, and you should consult your doctor.

4. Duration of Treatment:
- The effectiveness of topical treatments can vary. Some patients may notice improvement within a few days, while others may take longer. If symptoms persist after a week of treatment, it is advisable to follow up with your healthcare provider for further evaluation and potential alternative treatments.

5. Additional Findings:
- The presence of a "pimple-like" bump on the hemorrhoid could indicate a thrombosed hemorrhoid or an anal fissure. These conditions can cause additional pain and discomfort. If your doctor performed a rectal examination and did not mention any concerning findings, it is likely that they did not observe anything alarming. However, if you have persistent symptoms or new concerns, seeking a second opinion or further evaluation may be warranted.

In summary, managing internal hemorrhoids effectively requires understanding their grade and appropriate treatment options. If conservative measures fail or if you experience significant symptoms, surgical options such as rubber band ligation or hemorrhoidectomy may be considered. Always consult with a healthcare professional for personalized advice and treatment plans tailored to your specific condition.

Similar Q&A

Managing Internal Hemorrhoids: When to Consider Treatment Options

Hello Doctor, I have had hemorrhoids since my school days, but after turning 30, they started to prolapse without bleeding. This year, however, I began to experience bleeding. Earlier this year, I consulted a doctor who prescribed a hemorrhoid ointment and enteric-coated tablets...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Internal hemorrhoids will not resolve without active management. If there is frequent bleeding, it is advisable to discuss invasive treatment options with a surgeon, as the general risks are low.

Managing Discomfort from Hemorrhoids: Effective Treatment Options

Hello, Dr. Ke. Let me explain my situation. I have mixed hemorrhoids, and I treated three internal hemorrhoids using the ligation method in mid-July to August of this year. One of them seemed to have a failed ligation, so I went for another ligation at the end of October. Current...

Dr. Ke Fangxu reply Surgery
1. External hemorrhoids are defined as hemorrhoidal tissue located outside the dentate line, meaning that external hemorrhoids do not retract into the anal canal. Therefore, what you perceive as external hemorrhoids may not actually be external hemorrhoids, and it cannot be treat...

Managing Hemorrhoids: Alternatives to Surgery and Post-Operative Concerns

Hello, doctor. I have had hemorrhoids for many years (about twenty years). Although I have never seen blood in my stool, I have to wash with clean water after each bowel movement and push the protruding hemorrhoids back into the anus, which is not very convenient. However, seeing...

Dr. Ke Fangxu reply Surgery
Hello, Xiao Qiang: Generally speaking, if hemorrhoids have already protruded outside during a bowel movement and need to be pushed back in by hand, surgical treatment is likely to be the most effective option. If you prefer not to undergo surgery, the various non-surgical treatme...

Overcoming the Silence: Understanding and Treating Hemorrhoids

Hello: This issue has been with me for quite a while. I haven't seen a doctor because it's difficult to talk about. After each bowel movement, my hemorrhoids protrude. Based on information I found online, I believe I have grade 3 to 4 internal and external hemorrhoids. ...

Dr. Wang Qichao reply Surgery
Hello: If it is convenient for you, I would be happy to assist you. Sincerely, Dr. Wang Qi-Chao, Department of Surgery, Taoyuan Hospital.