Internal Hemorrhoids

Internal Hemorrhoids

external and internal hemorrhoidsInternal hemorrhoids or piles that originate inside the anal canal. These piles are so far inside your anal canal that you do not see or feel them.

Internal piles are commonly missed / unnoticed since the majority of them are usually asymptomatic. Internal piles are covered by mucous membranes, and generally, they don't hurt since there are fewer pain-sensing nerves in that area.

Nearly four out of five adults will have hemorrhoids from time to time. Most of the time, many will get relief from lifestyle modifications & home remedies.

How do internal hemorrhoids look like?

One usually can't see or feel internal piles, and they rarely cause discomfort unless your doctor diagnoses it. You might neglect simple and minor symptoms, but during bowel movements /Straining at the toilet, one can notice bright red blood in the toilet or tissue paper.

One can also notice lumps  that bulge outside the anus.These lumps  are usually pinker than the surrounding area & these are often referred to as prolapsed internal hemorrhoids.

Causes for Internal Hemorrhoids

Hemorrhoids have various causes, but most of the time, the cause is unknown.
Blood vessels inside the anus stretch during straining or under pressure and may bulge and swell, causing hemorrhoids.

Often it is due to

  • Increased straining during defecation
  • Chronic diarrhea & purgation
  • Sitting in the toilet for a longer time will also increase the pressure inside the lower rectum
  • Being obese/pregnant
  • Eating less fiber food and reduced intake of water
  • Anal intercourse

Symptoms of Internal Hemorrhoids

  1. Internal hemorrhoids rarely have noticeable symptoms.
  2. But one can have discomfort or irritation in the anal canal, mainly during bowel movements.
  3. You may also have painless bleeding through the anus during defecation.
  4. You may notice a bright red splash in the pan of the small amount of blood in the toilet or toilet paper after you wipe.
  5. Somehow heavy bleeding during straining can also occur (contact PROCTOCAN for early expert management)
  6. You may also notice pink fleshy mass descending through the anus during straining, which may cause pain or irritation it may reduce on its own or manually according to its severity.
  7. You can also have anal itching.
  8. Mucoid discharge.

If you experience any of the above signs and symptoms, Book an appointment at PROCTOCAN for further queries.

Who is at risk for internal hemorrhoids?

The risk of hemorrhoids increases as your age advances because of the weakening of tissues supporting veins in the rectum and anal canal.
It may also happen when there is increased intra abdominal pressure, which in turn increases pressure inside the rectum

For example,

  • Pregnancy
  • Any intra abdominal tumors
  • Chronic liver disease
  • Any colonic mass

[Note: hemorrhoids to get during pregnancy resolve on its own after delivery]


  • Internal hemorrhoids can seldom cause complications,
  • You can get anemia because of the constant chronic blood loss,
  • Piles may get strangulated and cause immense pain
  • A blood clot inside your piles may lead to Thrombosed Hemorrhoids, which should be managed effectively
  • Piles may Prolapse

How to diagnose internal hemorrhoids?

If you have any above-mentioned history, signs, and symptoms, consult your doctor for an early diagnosis, your doctor may do a Per Rectal examination or digital rectal examination [DRE] to confirm the diagnosis of hemorrhoids. Apart from DRE, proctoscopy can help in diagnosis.

In order to rule out other diseases, you might need other tests such as sigmoidoscopy & colonoscopy.

Best treatments for Internal Hemorrhoids

There are various modes of management for internal hemorrhoids starting from home remedies to surgical methods

  • home remedies – which include lifestyle modifications such as a high fiber diet, drinking more water, warm sitz bath
  • nonsurgical management such as over the counter creams, analgesics, laxatives, and stool softeners

These may relieve the pressure inside the anal canal and make you feel better, and get rid of it

  • Minimally invasive procedures such as
  • Lord’s dilatation (dilatation of anal sphincter)
  • Injection sclerosant therapy
  • Barron's banding (rubber band ligation)
  • Cryotherapy
  • Laser therapy
  • Infrared coagulation
  • Stapled hemorrhoidopexy

Newer methods such as harmonic scalpel therapy (using ultrasound)

How to prevent the Internal Hemorrhoids?

  • Keeping your stools soft may postpone the incidence of hemorrhoids. This can be achieved by
    1. Eating high fiber foods
    2. Drinking more liquids
    3. Adding fiber supplements
  • Avoid straining at the toilet, which may reduce your pressure inside the rectum
  • Don't postpone bowel movements – this may make your stools dry and hard to pass
  • Stay active and do regular exercises
  • Avoiding sedentary lifestyles

[contact Proctocan For more information regarding hemorrhoids]

When to go see a doctor?

On any occasion, if you notice bleeding through the anus or any other above mentioned symptoms, feel free to consult your doctor to make sure of the diagnosis. Since bleeding during bowel movements is not only due to hemorrhoids, you must rule out other medical conditions. Therefore, you should make an appointment to contact experts.

Seek emergency care in case if you have excess bleeding / acute pain or a change in bowel habits.

Connect to a proctologist through Proctocan for better results.