1. What are internal hemorrhoids?


Internal hemorrhoids are the result of swelling of the veins in the rectum, which are located inside the anal canal. This condition can occur due to increased pressure on the rectal veins. The rectum is the end of the large intestine that ends with the anus. These swollen veins can form small nodules or bumps that sometimes go unnoticed because they are usually not painful and cannot be felt or seen externally.


Anatomy of internal hemorrhoids


Internal hemorrhoids are located in the submucosal layer of the rectum, which is well supplied with blood vessels and supporting tissues. These blood vessels form plexuses (plexuses) that normally help control stools. With increased pressure or tension, these vessels can expand and become inflamed, leading to the formation of hemorrhoids.


Stages of development of internal hemorrhoids


Internal hemorrhoids go through different stages of development, which determine the severity of the condition:

  • First stage: Hemorrhoids are small and located inside the rectum. They may bleed slightly, but do not fall out of the anus;
  • Second stage: Hemorrhoids may fall out (prolapse) outside the anus when defecating, but retract on their own;
  • Third stage: Hemorrhoids fall out during defecation or physical exertion and must be retracted manually;
  • Stage four: Hemorrhoids are permanently outside the anus and cannot be retracted. They can be painful and cause significant discomfort.


Differences between internal and external hemorrhoids


Internal hemorrhoids differ from external hemorrhoids in their location and symptoms. While internal hemorrhoids are located inside the rectum and usually do not cause pain, external hemorrhoids are located under the skin around the anus and can be painful and inflamed. External hemorrhoids are easier to see and feel, while internal hemorrhoids are often diagnosed during a routine medical examination or when symptoms such as bleeding are present.


External and internal hemorrhoids difference


Clinical relevance


Internal hemorrhoids are significant because they can lead to complications if not treated in time. They can cause chronic bleeding, anemia, and in rare cases, rectal prolapse. That's why it's important to pay attention to early symptoms and seek medical help if necessary.


2. Causes of internal hemorrhoids


Genetic factors

Genetic predisposition plays an important role in the development of internal hemorrhoids. Some people inherit weakness of the vein walls, which increases the likelihood of developing hemorrhoids. This genetic vulnerability can be amplified by other lifestyle and health factors.


Improper nutrition

A diet low in fiber is a major risk factor for internal hemorrhoids. Inadequate fiber intake leads to constipation, which in turn causes straining during bowel movements.



Insufficient fluid intake can also lead to constipation and increased straining during bowel movements.


Sedentary way of life

Lack of physical activity is another important factor that contributes to the development of internal hemorrhoids. A sedentary lifestyle slows down intestinal peristalsis and increases the risk of constipation.


Pregnancy and birth

During pregnancy, the increased pressure in the abdominal cavity and the growing uterus can compress the rectal veins, leading to the development of hemorrhoids. Childbirth, especially natural childbirth, can also cause strain and damage to the veins in the rectum, leading to hemorrhoids.


Heavy physical exertion

Strenuous exercise, including heavy lifting, can increase the pressure on the veins in the rectum. People who frequently engage in heavy physical labor or intense sports are at a higher risk of developing internal hemorrhoids.


Heavy physical exertion


Chronic cough and vomiting

Chronic coughing and vomiting create additional pressure on the abdominal and rectal areas. This increased internal pressure can cause or worsen existing hemorrhoids.


Old age

As we age, the tissues that support the veins in the rectum and anus can weaken and stretch. This natural wear and tear on the tissues increases the risk of developing hemorrhoids in the elderly.


A diet high in fat and processed foods

A diet that is high in fat and processed foods can contribute to constipation and the development of hemorrhoids. These foods often contain little fiber and can make it difficult for the intestines to function normally.


Prolonged sitting and standing

Prolonged sitting or standing in one place increases the pressure in the rectal area. Sitting on hard surfaces for long periods of time is especially risky



Being overweight increases the pressure on the veins in the rectum, which can lead to the development of hemorrhoids.


3. Symptoms of internal hemorrhoids


Painless bleeding

One of the most common symptoms of internal hemorrhoids is painless bleeding. This bleeding is usually noticed after a bowel movement and can appear as bright red spots on the toilet paper or in the toilet bowl. It is important to note that rectal bleeding should always be evaluated by a medical professional as it may be a sign of other serious conditions.


Prolapse of hemorrhoids

Prolapsed hemorrhoids are a condition in which internal hemorrhoids protrude outside the anus, especially during bowel movements. In the initial stages, the hemorrhoids retract themselves back inside, but over time manual retraction may be required. In more severe cases, hemorrhoids remain outside the anus and can cause significant discomfort and pain.


Itching and irritation

Itching and irritation in the anal area are common symptoms of internal hemorrhoids. They are caused by discharge of mucus from the anus, which can cause skin irritation. This symptom is often accompanied by a burning sensation and discomfort.


A feeling of fullness or a foreign body

Many people with internal hemorrhoids experience a feeling of fullness or a foreign body in the rectum. This can be especially noticeable when having a bowel movement and can lead to a constant feeling of needing to go even when there is no need.


Mucus secretion

Mucus discharge from the anus is another symptom of internal hemorrhoids. This mucus can irritate the skin around the anus and contribute to itching and discomfort. In some cases, mucus secretion can lead to inflammation and infections if good hygiene is not maintained.


Difficulty with bowel movements

People with internal hemorrhoids often have difficulty having a bowel movement. This may include a feeling of incomplete emptying of the bowels or the need to strain significantly when passing a bowel movement. These symptoms can lead to further damage to the hemorrhoids and worsening of the condition.


Anorectal pain and discomfort

Although internal hemorrhoids are usually not painful, they can cause significant discomfort. Pain can occur if the hemorrhoids become thrombosed (their blood supply is interrupted) or if there are complications such as infection or inflammation. This pain can be sharp and severe, requiring medical attention.


Anorectal pain and discomfort


Changes in stools

Changes in the stool, such as the presence of blood or mucus, can be symptoms of internal hemorrhoids. It is important to have these changes examined by a doctor to rule out other possible causes such as inflammatory bowel disease or colon cancer.


Absence of external signs

One of the characteristic signs of internal hemorrhoids is the absence of visible external signs. Internal hemorrhoids cannot be seen or felt on external examination, which makes their diagnosis more difficult and requires specific medical tests such as anoscopy or sigmoidoscopy.


4. Diagnostics


Physical examination

Diagnosing internal hemorrhoids usually begins with a physical examination by a medical professional. A doctor may perform a digital rectal examination (DRE) by carefully inserting a gloved and lubricated finger into the rectum to feel for any unusual swellings or growths. This examination can help determine the presence of internal hemorrhoids and rule out other potential causes of symptoms, such as rectal tumors or polyps.



Anoscopy is a specific diagnostic method used to visualize internal hemorrhoids. In this procedure, the doctor uses an anoscope—a small, rigid tube with a light that is inserted into the rectum. Anoscopy allows a direct view of the anal canal and the lower part of the rectum, making it possible to assess the size, number and extent of hemorrhoids.



Proctoscopy is another diagnostic method that is used for a more detailed look at the rectum and the lower part of the large intestine. The proctoscope is a longer instrument than the anoscope and allows viewing of a larger part of the rectum. This procedure is useful when the presence of larger or higher located hemorrhoids is suspected, as well as to exclude other pathologies.



Sigmoidoscopy is a procedure that allows viewing of the lower part of the colon, including the rectum and sigmoid colon. This procedure uses a flexible sigmoidoscope that is inserted into the rectum and allows the doctor to see the inside of the intestine. Sigmoidoscopy is useful not only for the diagnosis of hemorrhoids, but also for the detection of other diseases such as diverticulosis, inflammatory bowel disease and colon cancer.



Colonoscopy is the most detailed diagnostic procedure for examining the colon and rectum. It uses a long, flexible colonoscope with a camera that allows the doctor to view the entire colon. Colonoscopy is recommended in patients with vague rectal symptoms, significant bleeding, or when more serious diseases are suspected. This procedure is especially important to rule out colorectal cancer and other serious conditions.


Virtual colonoscopy

Virtual colonoscopy, also known as CT colonography, is a non-invasive imaging procedure that uses computed tomography (CT) to create detailed images of the colon and rectum. This procedure is an alternative to traditional colonoscopy and can be used in patients who cannot tolerate invasive procedures.


Laboratory tests

In some cases, the doctor may order laboratory tests to assess the general health of the patient and to rule out other possible causes of the symptoms. These tests may include a complete blood count (CBC) to detect anemia that may be the result of chronic bleeding, as well as tests for inflammatory markers.


5. Types of treatment


Non-surgical treatment


Dietary changes and supplements

The main approach in the non-surgical treatment of internal hemorrhoids is a change in diet. Increasing your fiber intake by eating more fruits, vegetables, and whole grains can significantly improve symptoms. Fiber softens the stool and facilitates its passage through the intestines, which reduces straining during bowel movements.


Medicines and creams

Non-surgical treatment often involves the use of topical medications such as creams, ointments and suppositories. These products usually contain ingredients such as hydrocortisone or lidocaine that reduce inflammation and pain. Some creams also contain vasoconstrictors, which reduce the swelling of hemorrhoids.


Minimally invasive procedures


Ligation with rubber bands

Rubber band ligation is one of the most commonly used minimally invasive procedures for the treatment of internal hemorrhoids. In this procedure, the doctor places a small rubber band around the base of the hemorrhoid, which cuts off its blood supply. As a result, the hemorrhoid dries up and falls off within a few days. The procedure is quick and usually does not require anesthesia.



Sclerotherapy is another popular minimally invasive procedure. It involves injecting a sclerosant solution directly into the hemorrhoid. This solution causes the veins to constrict and form scars that reduce the size of the hemorrhoid. The procedure is relatively painless and can be performed on an outpatient basis.


Infrared coagulation

Infrared coagulation uses infrared light to coagulate the blood vessels in the hemorrhoid. This procedure causes the hemorrhoid to shrink and form scars. Infrared coagulation is a quick and effective procedure that can be performed in the doctor's office.


Surgical treatment



Hemorrhoidectomy is a surgical procedure to remove severe or prolapsed hemorrhoids. It is performed under general or regional anesthesia and involves removing the hemorrhoidal tissue. Although the procedure is more invasive and requires a longer recovery period, it is very effective in permanently relieving symptoms.


Hemorrhoidopexy (stapling)

Hemorrhoidopexy, also known as a stapler procedure, is a less invasive surgical technique. It involves the use of a surgical instrument (a stapler) that cuts off the blood supply to the hemorrhoids and returns them to the rectum. This procedure has a shorter recovery period than hemorrhoidectomy and is associated with less pain after surgery.


Alternative therapies


Herbal medicine and natural remedies

Some people prefer to use herbal and natural remedies to treat internal hemorrhoids. This may include taking extracts from plants such as witch hazel, aloe vera and horse chestnut, which have anti-inflammatory and soothing properties.



Acupuncture is an alternative therapy that can be effective in relieving the symptoms of internal hemorrhoids. It involves inserting thin needles into specific points on the body, which can help reduce pain and inflammation.


When to seek medical attention


If you have symptoms of internal hemorrhoids, consult a doctor. Early diagnosis and treatment can prevent complications. Do not ignore bleeding or severe pain.


Internal hemorrhoids are a common problem, but they can be managed effectively with the right approach. With appropriate lifestyle changes and medical care, symptoms can be alleviated and quality of life improved.



1. Mayo Clinic: Hemorrhoids (26 май 2024)