Internal Hemorrhoids

Just about everyone has heard of hemorrhoids but might not know that there are both internal hemorrhoids and external hemorrhoids. Internal hemorrhoids are often not that noticeable because they occur deep inside the rectum. They are not usually painful but they may bleed. So it is wise to start internal hemorrhoid treatment as early as possible.

Sometimes an internal hemorrhoid may stretch until it bulges outside the anus. This is what we call a prolapsed hemorrhoid and it may shrink back inside the rectum on its own over time or it may need to be gently pushed back inside. It is when the prolapsed hemorrhoid can no longer be pushed back that more specialist treatment is necessary, including hemorrhoid surgery.

For the past 25 years, doctors have used a grading system to classify internal hemorrhoids:

• Grade 1 hemorrhoids project into the anal canal and while they often bleed, they do not prolapse.
• Grade 2 hemorrhoids may protrude beyond the anal verge due to straining when passing a bowel movement but then reduce once more when straining ceases.
• Grade 3 hemorrhoids protrude spontaneously or without straining. They require manual reduction which means they need to be gently pushed back into the anal canal.
• Grade 4 hemorrhoids are chronically prolapsed and cannot be reduced. At this final stage, they contain both internal and external components and may present with acute thrombosis or strangulation.

To recap, internal hemorrhoids are those that occur inside the rectum and if left untreated, they can lead to 2 severe forms of hemorrhoids: prolapsed and strangulated hemorrhoids.

The main causes of all types of hemorrhoids in the first place are either straining on the toilet when making a bowel movement or being constipated. These causes need to be addressed as quickly as possible by changing to a healthy diet with plenty of fiber, fruit and vegetables and drinking lots of water, as well as making sure you live a healthy lifestyle too. You can treat hemorrhoids by applying ice packs for relief or sitting in a warm bowl of water several times per day. Both natural and over-the-counter products are available to treat hemorrhoids. The hemorrhoidal area can be very sensitive so be careful not to rub or scrub but use baby wipes soaked in witch hazel to clean.

If the condition is severe and have not responded to internal hemorrhoids treatment, hemorrhoid surgery may be advised by your doctor. There are several different methods which can be used for these chronic internal hemorrhoids:

• Hemorrhoidectomy which is the surgical removal of a hemorrhoid under an anesthetic.
• Laser coagulation which involves an electric current which is applied to the hemorrhoid via an electrode probe – the hemorrhoid then undergoes a chemical reaction that stops blood flow to the hemorrhoid and allows the swollen tissue to shrink.
• Infrared photocoagulation where an infrared light is used to coagulate the dilated vein which also promotes tissue shrinkage.
• Injection scleotherapy which is the injection of a chemical into the mucous membrane around the hemorrhoid causing closure of the vein and shrinking.
• Rubber band ligation which involves wrapping a small rubber band around the base of the hemorrhoid which cuts off the blood flow and causes the hemorrhoid to dry and fall off.
• Laser surgery which is a minimally invasive option. When a wide beam is used, laser can destroy large areas of tissue while if a narrow beam is used, it changes to a cutting tool.
• Stapled hemorrhoidectomy which is the latest method available where the stapling device bunches up the line of the rectum so that the prolapsed chronic hemorrhoids are pulled back inside again.

Once hemorrhoids have been successfully treated, you need to continue with your healthy diet and lifestyle so that they do not recur.