Internal Hemorrhoids Symptoms and Treatments

woman in discomfort

Hemorrhoids are swollen veins in the area of your anus or rectum. When the swollen vein is found within the lower rectum, it is characterized as an internal hemorrhoid. Thus internal hemorrhoids are those that are located above your anus. This is in contrast to external hemorrhoids which are located under the skin around your anus.

Although they are located above the anus, internal hemorrhoids can stick down through the anus.

Those that protrude are called prolapsed hemorrhoids, while those that have a blood clot in them are called thrombosed hemorrhoids.

Classification of Internal Hemorrhoids

Internal hemorrhoids are classified according to the degree to which they protrude out of the rectum:

  • First-degree: These internal hemorrhoids stick out into the anus, but do not get so far that they are on the outside of the anus.
  • Second-degree: These internal hemorrhoids will stick out during a bowel movement, but will retract on their own.
  • Third-degree: These internal hemorrhoids require that you use your fingers to push them back inside after a bowel movement.
  • Fourth-degree: These internal hemorrhoids stick out of the anus and will not retract even when they are pushed upward. Thrombosed hemorrhoids are classified as fourth-degree hemorrhoids.

Symptoms of Internal Hemorrhoids

Typically, internal hemorrhoids cause no pain.

If they bleed, you may see a small or large amount of bright red blood on the stool or on your toilet paper. Signs of blood may occur following a bowel movement, but not necessarily so. Internal hemorrhoids are the number one cause of painless gastrointestinal bleeding.

When internal hemorrhoids are prolapsed, you might experience discomfort, itching, or actual pain (although itching is more likely to be caused by an external hemorrhoid).

Other possible symptoms include some soiling, signs of mucus, and/or a feeling that you have not fully completed your bowel movement (incomplete evacuation). Thrombosed hemorrhoids may be especially painful.

Diagnosis of Internal Hemorrhoids

Internal hemorrhoids can typically be diagnosed by your physician during an office visit. They will look at the area of your anus and perhaps insert a finger into the anus (digital examination). An anal spectrum (anoscope) may be used. Your doctor may also choose to schedule you for a sigmoidoscopy or colonoscopy to rule out any other more serious diseases.

Self-Care Strategies for Internal Hemorrhoids

Most internal hemorrhoids shrink without any need for treatment. There are some things you can do to help to ease your symptoms:

  • Increase dietary fiber
  • Drinking a lot of water to help to keep stool soft
  • Exercising regularly
  • Do not strain while sitting on the toilet
  • Do not sit on the toilet for extended periods of time
  • Cleaning your anal area gently and thoroughly

Medical Treatment of Internal Hemorrhoids

First- and second-grade hemorrhoids may require topical treatments to ease the symptoms of discomfort and itch and to encourage shrinkage. Your doctor will make a recommendation as to which product or prescription is right for you.

For internal hemorrhoids that are resistant to treatment or are causing ongoing bleeding may require more intensive intervention. The options include:

  • Rubber band ligation
  • Injection sclerotherapy
  • Excisional hemorrhoidectomy
  • Stapled hemorrhoidopexy


"Hemorrhoids" National Digestive Diseases Information Clearinghouse. Accessed February 14, 2015.

Lohsiriwat, V. "Hemorrhoids: From basic pathophysiology to clinical management" World Journal of Gastroenterology 2012 18:2009–2017.

Lohsiriwat, V. "Treatment of hemorrhoids: A coloproctologist’s view" World Journal of Gastroenterology 2015 21:9245–9252.

Sanchez, C. & Chinn, B. "Hemorrhoids" Clinics in Colon and Rectal Surgery 2011 24:5–13.

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