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Internal Hemorrhoids 101: Your Complete Guide to Internal Hemorrhoids

Posted on 05 December 2017 by

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Internal hemorrhoids are a problem found among many adults today.

Also called piles, hemorrhoids are swollen veins in the anus and lower rectum.

They have many causes and can create symptoms such as itching, discomfort, and even bleeding.

Hemorrhoids are divided into three categories based on their location and characteristics.

The four categories are: internal hemorrhoids, external hemorrhoids, prolapsed hemorrhoids and thrombosed hemorrhoids.

Table of Contents:

What Are Internal Hemorrhoids?
How to Detect Internal Hemorrhoids
Are Internal Hemorrhoids Serious?
What Is an Internal Prolapsed Hemorrhoid?
Do Internal Hemorrhoids Cause Itching?
Can You Get Rid of Internal Hemorrhoids?
How to Get Internal Hemorrhoids to Stop Bleeding?
How Do I Get Rid of Hemorrhoids After Giving Birth?
How Big Can Internal Hemorrhoids Get?
How to Get Hemorrhoids Back In?

What Are Internal Hemorrhoids?

Internal hemorrhoids can be categorized by their location. They are called internal because they are located inside the rectum.

HemRid for internal hemorrhoids

These usually can’t be seen or felt, and rarely cause discomfort.

In fact, you may not even realize you have internal hemorrhoids. In some cases, the only indication that you have this type of hemorrhoid is bleeding.

This is generally caused by straining or irritation from passing a bowel movement. Damage to the hemorrhoids surface can cause noticeable bleeding.

Hemorrhoid bleeding may be a sign of a more serious problem, so get to the nearest hemorrhoid doctor when possible. 

Painful internal hemorrhoids are typically indicative of prolapsed hemorrhoids. A prolapsed hemorrhoid will stick out of the anus. There are 4 grades of internal prolapsed hemorrhoids.

How to Detect Internal Hemorrhoids

The most common sign of internal hemorrhoids is the presence of bright red blood on your toilet tissue after a bowel movement.

Because of the lack of nerve-endings inside of your anus, you should not have any pain with this type of hemorrhoid.

Other ways to detect internal hemorrhoids involve tests and procedures performed by a hemorrhoid doctor.

How to Detect Internal Hemorrhoids

A digital examination is the first step in doctor diagnosis. Your doctor will insert a gloved finger into your rectum during a digital rectal exam.

The purpose of this is to feel for any unusual growths. If your doctor feels anything unusual, he or she will likely suggest further testing.

Because many internal hemorrhoids go undetected, your doctor may do a visual inspection to provide a thorough diagnosis.

A visual inspection involves inserting a scope (anoscope) into the lower part of your colon and rectum to look for any visible signs of internal hemorrhoids.

The scopes used are small, fiber-optic cameras that are inserted into your rectum through a small tube.

They give your doctor a clearer view of what’s going on inside your rectum, and are essential in diagnosing hemorrhoids correctly (1).

Internal Hemorrhoid Causes

Internal hemorrhoids lie inside the rectum. They are not generally seen or felt. They rarely cause discomfort but can show symptoms when straining during bowel movements. There are many causes when it comes to internal hemorrhoids.

The most common causes of internal hemorrhoids include:

  • Straining during bowel movements
  • Chronic diarrhea
  • Chronic constipation
  • Obesity
  • Pregnancy
  • Low-fiber diet
  • Prolonged periods of time spent sitting, especially on the toilet
  • Poor hygiene
  • Heavy lifting
  • Genetics
  • Age

Internal Hemorrhoid Symptoms

Internal hemorrhoids do not generally display many symptoms. Internal hemorrhoids are in an area of the rectum that lacks pain-sensing nerves.

Because of this, the pain and discomfort generally associated with hemorrhoids does not usually exist with internal hemorrhoids. The most common symptom of internal hemorrhoids is painless bleeding.

When internal hemorrhoids progress, they tend to become more symptomatic. More severe internal hemorrhoids may protrude outside of the anus. An internal hemorrhoid that has protruded out of the rectum is called a prolapsed hemorrhoid.

When internal hemorrhoids get to this stage, the may have symptoms like external hemorrhoids. Prolapsed internal hemorrhoids may display symptoms of itchiness and swelling.

Are Internal Hemorrhoids Serious?

Internal hemorrhoids do not generally have associated complications. They are often not serious.

In rare occasions, internal hemorrhoids can develop blood clots which can be extremely painful.

Other rare complications include bleeding and anemia caused by chronic blood loss.

What Is an Internal Prolapsed Hemorrhoid?

On occasion, internal hemorrhoids can become prolapsed from straining during a bowel movement.

An internal prolapsed hemorrhoid is one that has been pushed through the anal opening.

Prolapsed hemorrhoids are classified by their degree of protrusion beyond the rectum.

Grade II prolapsed hemorrhoids prolapse out of the anal canal, but spontaneously retract on their own.

Grade III prolapsed hemorrhoids prolapse during exertion or from a strained bowel movement but can be manually returned into the rectum.

Grade IV internal hemorrhoids cannot be pushed back in once they have prolapsed out of the anal canal.

Do Internal Hemorrhoids Cause Itching?

Internal hemorrhoids do not generally cause hemorrhoid itching or burning.

In some cases, however, an internal hemorrhoid that is prolapsed will cause itching at the opening of the anal cavity or the very beginning of the anal canal.

Can You Get Rid of Internal Hemorrhoids?

Many internal hemorrhoids go away on their own and do not require treatment.

For internal hemorrhoids that do not go away on their own, home treatments and doctor treatments are available.

The best way to get rid of internal hemorrhoids is to practice proper hygiene and self-care at home.

Eat a high fiber diet, avoid straining during bowel movements, and practice good hygiene daily.

If you suffer from chronic constipation, try using a fiber supplement to reduce the likelihood that hemorrhoids will occur.

Also, hemorrhoid supplements can help with your hemorrhoids. Our hemorrhoid supplement reviews guide can help you choose the right supplement.

For internal prolapsed hemorrhoids that do not retract on their own, creams and suppositories are available.

If these do not work, your doctor may suggest a non-invasive procedure called a rubber band ligation (2). 

Check this blog post out for a guide on how to get rid of internal hemorrhoids.

How to Get Internal Hemorrhoids to Stop Bleeding

There are many ways to get internal hemorrhoids to stop bleeding. The best way is to understand what are the causes of hemorrhoids and work to prevent inflammation.

At home non-steroidal anti-inflammatories, like ibuprofen can help reduce bleeding in internal hemorrhoids.

Taking a sitz-bath can improve circulation to the area of your internal hemorrhoids and decrease the pressure that causes bleeding.

Alternating cold treatment with a towel-wrapped ice pack or hemorrhoid ice pak after soaking in a warm sitz-bath can be very effective in reducing bleeding.

Can you Get Rid of Internal Hemorrhoids Without Surgery?

internal hemorrhoids surgery

Most hemorrhoids will go away on their own without required treatment. There are many treatment options to try before surgery is a final resort.

At home remedies such as sitz-baths, dietary changes, and lifestyle changes can do the trick.

Over the counter creams and suppositories are also available.

There are also many non-invasive and non-surgical procedures. If you get to that point, your hemorrhoid doctor will go over the option that would work best for you.

Hemorrhoid laser surgery is a newer treatment that some seem to like. 

How Do I Get Rid of Hemorrhoids After Giving Birth?

Increased pressure from pregnancy can cause internal hemorrhoids. The treatment for postpartum hemorrhoids is the same as any other internal hemorrhoids.

While most will resolve on their own, once the pressure has decreased, at home remedies, high fiber diet, and preventing constipation can be effective in speeding up the process to rid your body of hemorrhoids after pregnancy by reducing constipation (3).

It is considered to be safe and effective to use hemorrhoid wipes after giving birth. This is a comprehensive list of the best hemorrhoid wipes to use for hemorrhoids after pregnancy.

How Big Can Internal Hemorrhoids Get?

The size of internal hemorrhoids is classified by four degrees based on how far a hemorrhoid protrudes.

First-degree hemorrhoids display a bulge in the anal canal.

Second-degree hemorrhoids bulge from the anus, but retract on their own.

Third-degree hemorrhoids bulge from the anus but can be pushed back in, and fourth-degree protrude from the anus all the time.

how big do hemorrhoids get

How to Get Hemorrhoids Back In

For internal prolapsed hemorrhoids that do not retract on their own, pushing them back in can be your solution. After cleaning the affected area, gently push the hemorrhoid back into the anus with your finger.

While internal hemorrhoids can be a nuisance, they are not life-threatening and generally do not cause any pain.

If you are concerned about your internal hemorrhoids, talk to you doctor for more information on your individual case.

Can I Use Epsom Salt for Internal Hemorrhoids?

Epsom Salt is an effective treatment to relieve the pain and inflammation of hemorrhoids.

When added to a warm bath, this can be a very helpful way to relieve symptoms.

Because internal hemorrhoids do not generally have any symptoms, and the benefits of Epsom Salt are for pain and inflammation, Epson Salt is more effective for external hemorrhoids rather than internal ones.

Internal Hemorrhoid Treatment Options

Treatment options for internal hemorrhoids vary depending on the severity and symptoms of your condition. Treatments include natural remedies, at-home treatments, and even medical procedures. Internal hemorrhoid treatment options are:

Lifestyle changes as a form of natural treatment. Lifestyle changes that are effective in treating internal hemorrhoids are:

  1. Increasing your fiber intake. When you add more fiber to your diet, it keeps your bowels moving easily. Consuming the proper amount of fiber also helps you avoid constipation, which is a common cause of internal hemorrhoids. High-fiber foods don’t just decrease your likelihood of getting internal hemorrhoids. They also help decrease hemorrhoidal bleeding and reduce inflammation and enlargement of your veins. If you are unable to maintain your daily recommended fiber intake through the foods you consume, fiber supplements are available.
  2. Hydrate. In addition to increasing your fiber intake, it is important to increase your water intake. Adequate water intake helps fiber move through your digestive system. Proper hydration also helps soften your stool.
  3. Exercise. Healthy diet isn’t the only lifestyle change that can help internal hemorrhoids. By increasing your daily aerobic exercise by just thirty minutes a day, you can help stimulate bowel function.
  4. Improve your bowel habits. One of the leading causes of constipation is waiting to use the bathroom when you have the urge to go. If you feel the urge to have a bowel movement, go immediately. By waiting, stool can back up, increase the pressure in your rectum, and become dry and hard. This will add to straining when you do have a bowel movement. Also, make sure you are properly cleaning yourself after each bowel movement.

At-Home Treatment. There are many at-home treatment options that are effective in treating internal hemorrhoids.

At-home treatments include:

  1. Sitz baths. Sitting in a few inches of warm water for 15-20 minutes a few times a day can help relieve swelling associated with prolapsed hemorrhoids. Pharmacies also carry plastic tubs that fit over the toilet seat. Also, be sure to pat your anal area dry rather than wiping.
  2. Natural supplements. There are many natural supplements available to treat internal hemorrhoids. Aloe vera, witch hazel, and coconut oil are all effective in treating internal hemorrhoids.

Over-the-counter medications. There are several over-the-counter medications available to treat internal hemorrhoids, including:

  1. Anti-inflammatory medications. Anti-inflammatory, pain reducing drugs can help reduce the swelling associated with internal hemorrhoids and alleviate any pain from prolapsed hemorrhoids.
  2. Hemorrhoid creams. There are many hemorrhoid creams and ointments on the market to treat internal hemorrhoids. They contain ingredients that soothe hemorrhoids and alleviate other symptoms. There are also medication wipes available.
  3. Suppositories. Suppositories have been proven to be very effective in treating internal hemorrhoids. They help reduce inflammation and effectively treat internal hemorrhoids.

Medical procedures. If these options are not effective in treating internal hemorrhoids, medical treatments may be necessary. Medical procedures for internal hemorrhoids include:

  1. Rubber Band Ligation. During a rubber band ligation, your doctor will place a small, tight band around the base of your hemorrhoid. This causes the hemorrhoid to shrink and the surrounding tissue to scar and keep the hemorrhoid tissue in place as it heals.
  2. Sclerotherapy. This medical procedure is similar to banding, although your medical provider will inject a chemical solution into the hemorrhoid. This causes the hemorrhoid to shrink and die. Infrared coagulation. Infrared coagulation involves the use of infrared light, heat, or extreme cold to shrink the hemorrhoid and help the tissue heal.
  3. Hemorrhoidopexy. A hemorrhoidopexy, also called stapling, is a more serious medical procedure. If minimally invasive procedures without anesthesia aren’t an effective treatment, surgery may need to be performed under anesthesia. During a hemorrhoidopexy, a medical stapling device is used to anchor the hemorrhoid into its normal position. Once stapled, the hemorrhoid will lose its blood supply and shrink into place.

What is the Best Internal Hemorrhoids Surgery

There are two major types of surgery to treat hemorrhoids. While a hemorrhoidectomy is commonly used to treat external hemorrhoids, a hemorrhoidopexy is used the best option for internal hemorrhoids.

Also known as stapling, the surgical procedure is most effective in treating prolapsed internal hemorrhoids.

What is the Best OTC Medication for Internal Hemorrhoids?

The best over-the-counter medications to treat internal hemorrhoids come in the form of suppositories.

Over-the-counter suppositories allow medication to be delivered directly to the source of the hemorrhoid.

They include ingredients such as hydrocortisone and antihistamine to treat internal hemorrhoids.

Internal Hemorrhoids Herbal Treatment

The best treatment for any type of hemorrhoid is prevention.

The natural cures for internal hemorrhoids include a change in lifestyle habits.

You can improve your diet by adding high-fiber foods which can reduce the risk of symptoms and bleeding associated with internal hemorrhoids.

In addition, you should drink plenty of water, limit alcohol consumption, and avoid spicy foods.

Dehydration, alcohol consumption, and eating spicy foods have all been known to be risk factors for internal hemorrhoids.

Another diet change is the introduction of fermented foods like yogurt.

This can help the digestive system and improve intestinal health, which is essential to healthy bowel movements.

Also, be sure to try out only the best products for categories, which can be seen below.

Does Vitamin E for Internal Hemorrhoids Work?

Vitamin E is often used topically for hemorrhoids. It can help to relieve the pain, itching, and discomfort of external hemorrhoids.

Instead of Vitamin E, we recommend witch hazel for hemorrhoids as it is commonly used in the best OTC medicines

Vitamin E supplements, taken orally, can help improve blood circulation and promote the growth of connective tissues, but a supplement like HemRid will work better, in my opinion.

By enhancing the nutrients in your body, you can reduce the effects of internal hemorrhoids.

If you are interested in using vitamin E for hemorrhoids, you may want to try tea tree oil for hemorrhoids instead.

Can You Get Rid of Internal Hemorrhoids Without Surgery?

It is possible to get rid of internal hemorrhoids without surgery if you follow the proper treatment and talk to your medical provider.

Since most internal hemorrhoids are not symptomatic, most people don’t realize they have internal hemorrhoids unless they become prolapsed or begin to bleed.

If you experience these characteristics of internal hemorrhoids, you can possibly resolve the problem without hemorrhoid surgery.

Proper hemorrhoid treatment can be as simple as better hygiene practices, improving your diet, or using over-the-counter treatment products.

How Long Do Internal Hemorrhoids Take to Go Away?

Internal hemorrhoids usually go away in a few weeks.

In many cases, it is difficult to tell how long internal hemorrhoids have been going on because they are not usually symptomatic.

How long hemorrhoids last depends on their location and severity.

Internal hemorrhoids can last one or two days or as long as a few months. Prolapsed internal hemorrhoids generally take a long time to heal.

Do Internal Hemorrhoids Go Away on Their Own?

Internal hemorrhoids do not go away on their own, but you may not even notice you have them because they only have symptoms when they are severe.

Sneak a peak at our do hemorrhoids go away guide for more information.

Best Prescription Medication for Internal Hemorrhoids

The most frequently used medications for internal hemorrhoids are called Anusol HC and Preparation H.

Anusol comes as both a cream and a suppository.

Suppositories are often more effective than creams and are the best choice for internal hemorrhoids.

The generic of Anusol HC is hydrocortisone acetate.

The medication contains a much stronger dose of corticosteroids to reduce the swelling associated with hemorrhoids.

Are Internal Hemorrhoids Hard?

Internal hemorrhoids can be soft lumps inside the anus. When an internal hemorrhoid becomes prolapsed, it can protrude as a hard lump.

Can Internal Hemorrhoids Hurt?

Internal hemorrhoids are located far enough inside the rectum that they do not generally hurt.

There are few pain-sensing nerves where they are located, reducing the likelihood of pain.

If you have hemorrhoid pain, there are many different products that can help. Visit this link for a list of the best hemorrhoid products of 2018.

HemRid for internal hemorrhoids

Internal Hemorrhoid Surgery Recovery Time

While you will be expected to reduce and/or eliminate activity after a hemorrhoidectomy, you should be able to resume normal activity one to two weeks after your surgery.

Studies have shown infrared photocoagulation surgery to require shorter recovery times than the traditional hemorrhoidectomy (3).

Light bleeding or pain can last for up to one or two months after surgery, depending on the surgery method chosen.

More Frequently Asked Questions

What Causes Internal Hemorrhoids?

Many factors can result in the inflammation of the cushion of blood vessels known as internal hemorrhoids, or sometimes called piles. 

Scientific research points to chronic conditions such as diarrhea and constipation as the leading causes of inflammation of these blood vessels.

Passing hard stools can increase the chance of them scraping against the delicate inner lining of the rectum, and this is why you will see blood after a bowel movement. 

Hard stools are the result of constipation and the main culprit behind internal hemorrhoids.  Your doctor will likely recommend a high fiber diet if you are suffering from internal hemorrhoids.

How do You Stop Internal Hemorrhoid Bleeding?

Rectal bleeding is sometimes the only symptom of the presence of internal hemorrhoids. 

This painless bleeding happens when a hardened stool tears the soft inner lining of the rectum and causes more disruption to the already inflamed blood vessels.  To stop internal hemorrhoid bleeding, try including more fiber in your diet. 

A fibrous diet will soften your stools, making them easier to pass and causing less strain on your hemorrhoids during a bowel movement. 

Drinking plenty of water throughout the day can help, too. 

Your stools will retain this moisture and combined with the fibrous diet, make them easier to pass.

How Long do Internal Hemorrhoids Last?

In mild cases of internal hemorrhoids, they will often last a few days to weeks. 

Fortunately, this condition resolves itself on its own, even without treatment.  Internal hemorrhoids are not considered to be a concerning condition and do not produce many symptoms other than painless rectal bleeding. 

In more severe cases of internal hemorrhoids, the hemorrhoid will become prolapsed and fall through the rectum.

While the prolapsed hemorrhoid can be gently pushed back through the rectum, it may take a little longer to heal, and you may need to consider consulting your doctor about other treatment options.

How Do You Shrink Internal Hemorrhoids? 

The best method to shrink and resolve internal hemorrhoids is through diet, hydration, and exercise. 

In most cases of internal hemorrhoids, constipation is a repeated issue in the inflammation of these blood vessels. 

Treating chronic constipation can, in turn, shrink internal hemorrhoids. 

A fibrous diet full of fruits, vegetables, legumes, beans, whole grains, and nuts softens stools, makes the colon regular, and promotes less strained bowel movements, all of these factors can aid in shrinking internal hemorrhoids. 

Exercise helps improve circulation and regular bowel movements and drinking plenty of water allows stools retain water to become soft and comfortable to pass.

Can Internal Hemorrhoids be Removed?

There are surgical options that can remove internal hemorrhoids.  A hemorrhoidectomy is an invasive surgical procedure in which your doctor removes an internal hemorrhoid in its entirety. 

A hemorrhoidectomy is an aggressive surgery that is meant to treat persistent or severe cases of hemorrhoids, and while you can use this method to remove internal hemorrhoids, it is often recommended as one of the last treatment options. 

In the cases of prolapsed internal hemorrhoids in which a hemorrhoid has fallen through the rectum, some procedures can remove them such as rubber band ligation. 

This non-operative procedure cuts off the blood supply of a prolapsed hemorrhoid, forcing it to fall off.

Can Internal Hemorrhoids Cause Back Pain? 

It can be easy to confuse the cause of back pain with hemorrhoids because in many cases, back pain originates from the tailbone, the same area where hemorrhoids form. 

Internal hemorrhoids occur when there is pressure, stress, or strain on the lower half of your body, specifically in the lower rectal area. 

Back pain can run all along the course of your spine, including the base, an area that can share the same pain as hemorrhoids. 

However, no scientific link connects hemorrhoids, especially internal hemorrhoids, to back pain.  Internal hemorrhoids are painless until they become prolapsed.

How Big Can Internal Hemorrhoids Get?

Hemorrhoids sizes and severities are rated in different grades

  1. Grade 1 is considered to consist of slightly enlarged hemorrhoids but is not visible from outside the anus, specifically, internal hemorrhoids.
  2. Grade 2 is comprised of more sizable hemorrhoids, sometimes slipping and becoming prolapsed outside of the anus, but going back inside the rectum on their own.
  3. Grade 3 hemorrhoids do not go back inside on their own and notably more substantial than the previous grades.
  4. Grade 4 is similar to Grade 3 but can include the potential prolapse of the rectum.  Grade 4 hemorrhoids do become quite large, as there is a longer, larger prolapse that occurs.

Can Internal Hemorrhoids Cause Stomach Pain?

Internal hemorrhoids do not cause stomach pain.  If you have stomach pain, it is likely being created from a separate condition. 

Constipation is a primary cause of internal hemorrhoids and can also be the source of the stomach pain you are experiencing. 

There is a possibility that you are not getting enough fibrous food in your diet and this can upset your stomach due to an irregular colon and difficult to pass stools. 

The only symptom of internal hemorrhoids is rectal bleeding, and this is almost always painless, most of the time rectal bleeding occurs directly after a bowel movement.

Can Internal Hemorrhoids Cause Bloating? 

While internal hemorrhoids do not cause bloating, constipation might.  Constipation is the primary reason why internal hemorrhoids become inflamed and irritated, and this chronic condition could be a result of your diet. 

Bloating could also be an indication of indigestion or lack of fiber, a nutrient needed to push food waste along through your body and an essential aid in a healthy colon.

Bloating can take place due to numerous reasons, but internal hemorrhoids are not one of them. 

Internal hemorrhoids are challenging to detect and in many instances, can only be made aware of with occasional rectal bleeding. 

If you are experiencing bloating, try taking fiber supplements or stool softeners.

Are Internal Hemorrhoids Hard or Soft? 

Internal hemorrhoids are considered to be soft because they consist of a collection of blood vessels that form in the lowest part of the rectum. 

Internal hemorrhoids become inflamed and irritated, although we do not feel any pain or discomfort with this type of hemorrhoid. 

This area of the rectum lacks pain-sensing nerves, which is why we hardly ever know if our internal hemorrhoids are inflamed. 

When an internal hemorrhoid becomes prolapsed, it might feel soft to the touch, as it is a cushioning of blood vessels. 

Prolapsed hemorrhoids can return inside the rectum on their own, but you can also gently nudge them back through the anal opening with your fingers.


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