Internal hemorrhoids

What are internal hemorrhoids?

Hemorrhoids are swollen rectal veins in the lower areas of the rectum and anus.

When they stretch and get very thin, they cause symptoms, including pain and bleeding.

Internal hemorrhoids are higher up than external hemorrhoids but they can also be seen when they swell and protrude.


Symptoms of internal hemorrhoids

  • Internal hemorrhoids do not cause SKIN PAIN
  • Bleeding
  • Perianal itching/pruritus ani
  • Sphincter pain: Perianal pain from prolapsed hemorrhoids that is due to spasm of the anal sphincter
  • Incarcerated and strangulated internal hemorrhoids cause pain

The symptoms that occur together due to hemorrhoids are called acute hemorrhoidal crisis.

Causes of internal hemorrhoids

  • Aging: commonest between age 45 to 65 years
  • Long standing Diarrhea
  • Long-standing constipation with straining
  • Liver disease
  • Previous episiotomy
  • Pregnancy
  • Sitting for too long, including in the toilet
  • Lifting heavy weights
  • Anal sex
  • Heredity: some people are predisposed to hemorrhoids.
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Powerful agent against hemorrhoids and rectal fissures

Physical Examination of internal hemorrhoids

  • If the internal hemorrhoids have prolapsed, they can be seen by visual inspection. They are usually dark pink, shiny, and sometimes painful when touched.
  • Internal hemorrhoids that have not prolapsed can be examined by anoscopy. They appear as swollen purplish-blue veins.

Internal hemorrhoids are classified according to their degree of prolapse.

  1. Grade 1hemorrhoids: may bleed but there is no protrusion
  2. Grade 2 hemorrhoids: protrude with defecation but go back in without intervention
  3. Grade 3 hemorrhoids: protrude and have to be reduced manually
  4. Grade 4 hemorrhoids: permanently prolapsed that requires intervention

Other conditions that may give rise to similar symptoms

  • Anal cancer
  • Anal warts
  • Anal fissure
  • Colorectal cancer
  • Ulcerative colitis
  • Peri-anal abscess
  • Skin tags
Your doctor will examine you carefully to make sure that your symptoms are not due to any of the other conditions above.

Treatment of internal hemorrhoids

Treatment depends on the severity of the protrusion (that is, the grade) and the presence of other symptoms like pain or bleeding.
Internal hemorrhoid grade
Surgical procedure
Grade 1
Rubber band ligation; excisional hemorrhoidectomy
Grade 2
Rubber band ligation; excisional hemorrhoidectomy
Grade 3
Rubber band ligation; excisional hemorrhoidectomy
Grade 4
Excisional hemorrhoidectomy; stapled hemorrhoidopexy
Rubber band ligation causes less pain than the other surgical treatments, but relapses occur more frequently.



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