What are the symptoms of internal hemorrhoids?

Nov 14, 2025 Source: Cainiu Health

Dr. Li Jingxiang

Introduction

Symptoms of internal hemorrhoids include rectal bleeding, prolapse of hemorrhoidal tissue, perianal itching, a sensation of heaviness or fullness in the anus, and discomfort during defecation. The severity of symptoms is related to the size of the hemorrhoidal tissue and disease progression, and the condition should be assessed based on specific clinical presentations. Prompt medical attention is recommended if there is heavy bleeding or if prolapsed tissue cannot be reduced. Bright red blood may appear during or after bowel movements, presenting as dripping blood, jet-like bleeding, or blood on toilet paper.

Internal hemorrhoids may present symptoms such as rectal bleeding, prolapse of hemorrhoidal tissue, perianal itching, a sensation of heaviness or fullness in the anus, and discomfort during defecation. The severity of symptoms is related to the size of the hemorrhoidal tissue and disease progression, so clinical evaluation should be based on specific manifestations. If heavy bleeding occurs or prolapsed tissue cannot be reduced, prompt medical attention is recommended.

1. Rectal bleeding: Bright red blood appears during or after bowel movements, often seen as dripping blood, spurting, or blood-streaked toilet paper. The blood is typically鲜red and does not mix with stool, usually caused by rupture of blood vessels due to friction between feces and the mucosa covering the hemorrhoid.

2. Hemorrhoidal prolapse: In early stages, tissue protrudes during defecation but spontaneously reduces afterward. As the condition progresses, the prolapsed tissue becomes larger and must be manually pushed back; in severe cases, it may protrude even during walking or coughing, significantly affecting daily activities.

3. Perianal itching: Prolapsed hemorrhoids increase mucus secretion, which irritates the perianal skin. Moisture from retained secretions can lead to itching. Excessive scratching may further damage the skin.

4. Anal heaviness or fullness: When internal hemorrhoids become congested, swollen, or infected, patients may experience a persistent sensation of pressure or dull pain in the anal area, especially noticeable after bowel movements or prolonged sitting or standing. Some individuals may also feel a sense of heaviness in the lower abdomen.

5. Discomfort during defecation: The presence of hemorrhoidal tissue within the anal canal or irritation of the rectal mucosa may cause a feeling of incomplete evacuation, straining during bowel movements, or mild pain, disrupting normal defecation patterns.

To manage symptoms and reduce risk of worsening, maintain a light diet rich in dietary fiber, and avoid spicy or irritating foods. Establish regular bowel habits and avoid prolonged straining or sitting on the toilet. Keep the perianal area clean and dry, and perform moderate anal sphincter contraction exercises regularly.

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What do hemorrhoids look like?

These lesions are categorized into internal and external hemorrhoids. Internal hemorrhoids are clusters of varicose veins located above the dentate line of the anal canal and cannot be directly observed. When internal hemorrhoids develop to a certain extent and prolapse outside the anus, they present as mucosal elevations appearing dark red or purplish red, with a soft surface, and sometimes accompanied by bleeding. External hemorrhoids are located below the dentate line, and skin tags or masses can be observed around the anus; in the early stages, they may appear as soft skin elevations.

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Can a colonoscopy detect internal hemorrhoids?

A colonoscopy can detect internal hemorrhoids, clearly revealing their location, size, number, and mucosal condition, while simultaneously screening for other intestinal abnormalities. If symptoms such as rectal bleeding, anal heaviness, abdominal pain, or changes in bowel habits occur, prompt medical evaluation is recommended. Internal hemorrhoids are located at the distal end of the rectum near the anus, and a colonoscope can be inserted through the anus into the rectum and colon to directly visualize the morphological characteristics of the hemorrhoids.

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When is surgery not necessary for hemorrhoids?

Whether hemorrhoids require surgery generally depends on the severity of symptoms. Surgery is usually not needed for mild internal hemorrhoids, asymptomatic external hemorrhoids, mild hemorrhoids during pregnancy, mixed hemorrhoids that have improved with conservative treatment, or occasional minor bleeding. If internal hemorrhoids only occasionally cause slight discomfort after bowel movements, without prolapse or significant bleeding—especially when symptoms can be relieved through dietary adjustments and regular bowel habits—surgical intervention is typically unnecessary.