Internal Hemorrhoids: Symptoms, Grades, Causes & 7 Treatments

Internal hemorrhoids are swollen veins inside the rectum that can cause bright red bleeding during bowel movements, anal itching, discomfort, and pain. They are classified into four grades based on how far they protrude, which helps determine the most appropriate treatment.

Internal hemorrhoids are often linked to a low-fiber diet, prolonged sitting on the toilet, chronic straining, pregnancy, and other factors that increase pressure on the rectal veins. Although they are usually not serious, persistent bleeding or worsening symptoms should be evaluated.

Treatment for internal hemorrhoids depends on their severity and may include increasing fiber and fluid intake, taking sitz baths, using hemorrhoid medication, or undergoing office-based procedures. Surgery may be recommended for more severe or prolapsed hemorrhoids that do not respond to other treatments.

Grades of internal hemorrhoids

Internal hemorrhoids are classified into four grades based on their symptoms and how far they protrude. The grade helps determine the most appropriate treatment.

• Grade 1: Bleeding may occur, but the hemorrhoids do not protrude through the anus.

• Grade 2: The hemorrhoids protrude through the anus during a bowel movement but return inside on their own. Bleeding may also occur.

• Grade 3: Bleeding may occur, and the hemorrhoids return inside only when they are gently pushed back.

• Grade 4: Heavy bleeding may occur, and the prolapsed hemorrhoids cannot be pushed back inside.

A gastroenterologist or colorectal surgeon can determine the hemorrhoid grade based on your symptoms and the findings from a physical examination. The grade helps guide the most appropriate treatment.

It is important to see a healthcare provider if you develop symptoms of internal hemorrhoids, especially rectal bleeding. A healthcare provider can confirm the diagnosis, rule out other possible causes, and recommend the most appropriate treatment.

Main symptoms

The main symptoms of internal hemorrhoids are:

• Bright red blood in the stool

• Anal itching

• Mucus discharge from the anus

• Difficulty or pain with bowel movements

• Anal discomfort

• Rectal tenesmus, which is a strong urge to have a bowel movement even when there is no stool left to pass

• A feeling that the rectum has not emptied completely after a bowel movement

A small lump may also appear at the anus during a bowel movement. This lump may return inside the rectum on its own or remain outside and consists of swollen veins that have prolapsed through the anus. Depending on its characteristics, this may indicate grade 2, 3, or 4 internal hemorrhoids.

How long do hemorrhoids last?

How long internal hemorrhoid symptoms last depends on their grade and severity. Mild cases often improve within a few days, although full recovery may take up to one week. Healthy eating habits can help promote recovery.

Larger or more severe internal hemorrhoids may take 2 to 3 weeks to improve. If symptoms persist, a healthcare provider can recommend the most appropriate treatment.

Confirming a diagnosis

Internal hemorrhoids can be diagnosed by a healthcare provider through a physical examination of the anal and rectal area. If needed, you may be referred to a gastroenterologist or colorectal surgeon for further evaluation or treatment.

During the examination, the healthcare provider may ask you to lie in a specific position before examining the anus. You may also be asked to bear down as if having a bowel movement, which can help reveal prolapsed hemorrhoids or anal fissures.

The healthcare provider will also ask about your symptoms, medical history, eating habits, and physical activity level. A low-fiber diet and a sedentary lifestyle can contribute to hemorrhoids.

Are internal hemorrhoids serious?

Internal hemorrhoids are generally not serious, but they can cause pain, discomfort, and bleeding. They may also increase the risk of anemia, infection, or strangulation of prolapsed hemorrhoidal tissue.

A healthcare provider should be consulted when symptoms do not improve. This allows the cause to be diagnosed and the most appropriate treatment to be started.

Main causes

Internal hemorrhoids are often associated with habits such as:

• Eating a low-fiber diet

• Frequent use of laxatives

• Sitting on the toilet for long periods

• Smoking

• Leading a sedentary lifestyle

A low-fiber diet can slow digestion and make stools harder and more difficult to pass. This can lead to straining during bowel movements and contribute to the development of hemorrhoids.

Internal hemorrhoids may also be linked to local infections or chronic diarrhea. They are also common during pregnancy because increased body weight and pressure from the growing uterus can place more strain on the pelvic area.

What makes hemorrhoids worse

Hemorrhoid symptoms may worsen after eating high-fat foods, refined grains, foods made with refined flour, or spicy foods, as well as drinking alcohol or caffeinated beverages. Sitting for long periods, straining during bowel movements, and delaying a bowel movement can also make symptoms worse.

A balanced diet with enough fiber and fluids can help soften stool, reduce straining, and support recovery.

Treatment options

Treatment for internal hemorrhoids depends on the hemorrhoid grade and should be guided by a healthcare provider. According to the American Society of Colon and Rectal Surgeons, increasing fiber and fluid intake and avoiding straining are recommended as first-line measures for symptomatic hemorrhoids.

Recommendations may include:

• Prioritizing high-fiber foods
• Drinking plenty of fluids throughout the day
• Taking a sitz bath
• Using acetaminophen if pain relief is needed
• Using a hemorrhoid cream or suppository recommended by a healthcare provider

Other hemorrhoid treatments may be recommended depending on the hemorrhoid grade. Based on guidelines from the American Society of Colon and Rectal Surgeons, rubber band ligation is generally considered the most effective office-based treatment, while infrared coagulation and sclerotherapy may also be used for some internal hemorrhoids.

In more severe cases, a prolapsed hemorrhoid may become trapped outside the anus. This can reduce its blood supply or lead to blood clot formation, and surgery may be needed to remove or repair the affected hemorrhoidal tissue.