INTERNAL HEMORROIDS: causes, symptoms, main treatments and remedies


What are internal hemorrhoids? The internal hemorrhoids they represent dilation of the haemorrhoidal veins that form vascularized cushions, present inside the wall anal, whose role is to ensure the proper functioning of the continence. They are therefore naturally present in the human body and usually their presence is not perceived. On the other hand, they can cause considerable discomfort when they tend to expand excessively.

If the hemorrhoidal veins should they dilate excessively, the first symptoms felt are stinging, itching, bleeding or even the prolapse of the hemorrhoids themselves to the outside (external hemorrhoids). In all these cases it is advisable to contact your doctor who will carefully evaluate the type and level of severity of the haemorrhoidal disease. Unlike external hemorrhoids, internal hemorrhoids are generally less painful.


The hemorrhoids can be divided into four degrees classification. Each grade differs from the other in severity and symptomatology:

  1. The first degree hemorrhoids are the least severe and are accompanied by painless bleeding. In this case, the hemorrhoids are visible only through an anoscopic examination because they are located inside the anal wall;
  2. The second degree hemorrhoids, also internal to the anal canal, are often accompanied by episodes of prolapse during evacuation but tend to return spontaneously. They involve discomfort and bleeding;
  3. The third degree hemorrhoidal produces a complete prolapse of the hemorrhoids outside the rectal canal. They must therefore be repositioned manually or through surgery;
  4. The fourth and last degree produces an irreversible prolapse of the hemorrhoids that cannot be repositioned within the anal wall.


The causes of internal hemorrhoids they are numerous and varied. Some factors are mainly related to the style and quality of life led by the person affected by the haemorrhoidal disease, others depend on hereditary elements or external factors.

Below, here are the main causes of hemorrhoids:

  • excessive stress or a sedentary lifestyle, related to being overweight;
  • poorly balanced diet, rich in fatty, spicy foods, alcoholic beverages, spices and low in fiber. In the presence of symptoms related to hemorrhoidal disease it is necessary to minimize the consumption of all foods that can irritate the mucous membrane of the anal walls;
  • poor hydration;
  • hereditary factors or congenital fragility of the vessel walls;
  • constipation or constipation phenomena;
  • prolonged antibiotic treatment (in this case the effects are transient);
  • hormonal changes;
  • excessive physical exertion;
  • reckless use of laxative drugs.
Internal hemorrhoids

Internal hemorrhoids, still confined within the anal canal.


The main symptoms to consider for a correct diagnosis of haemorrhoidal disease are:

  • rectal bleeding, characterized by an intense and bright color. In first degree hemorrhoids it is the only visible symptom;
  • pain, the intensity of which can vary in relation to the degree of haemorrhoid disease;
  • annoying mucosal discharge;
  • itching and burning sensation that can make even simple movements complex;
  • foreign body sensation;
  • congested internal hemorrhoids with prolapse, characteristic of the third and fourth stages of hemorrhoidal pathology.

The bleeding internal hemorrhoids are, very often, accompanied by sensations of itching e acute burning. The hemorrhage, which occurs in conjunction with defecation, is characterized by an intense red color and in cases of first and second degree hemorrhoids it is mild.

The annoying feeling of itch it is caused by the mucus produced by internal hemorrhoids which irritates the anal walls. Another equally annoying aspect is represented by the sensation of a foreign body that is caused by the prolapse of internal hemorrhoids. Prolapsed or thrombosed hemorrhoids involve a very acute pain sensation. In severe cases, hemorrhoid prolapse can cause hemorrhoidal thrombosis.

It often happens that the symptoms described above appear at more or less long time intervals. The worsening of internal hemorrhoid symptoms can be caused by the patient's physical changes (such as a pregnancy) or by lifestyle changes. Excessive or repeated effort in the gym or at work, an unbalanced diet or long journeys that subject the body to a massive dose of stress, can all be contributing causes of the flare-up of internal hemorrhoid symptoms.

The ache related to internal hemorrhoids is generally mild. It is most often associated with the presence of an anal fissure. The fissures are particular erosions of the skin that can appear near the anus or the mouth. Specifically, the anal fissures they can be defined as small cuts caused by excessive dilation of the anal walls during defecation. The disorder can be accentuated by episodes of constipation.

As far as prolapse is concerned, it occurs in cases where the size of the vascularized cushions increases excessively, causing a subsequent prolapse of the connective tissue and therefore the release of the hemorrhoids from the anal canal.

In second-degree hemorrhoids, the prolapse is reduced spontaneously, while in more severe cases (third and fourth degree) manual or surgical intervention is required. In extreme cases it is not possible to reduce the prolapse.

The doctor will have to evaluate the extent and severity of the prolapse in a precise and careful manner. Only in this way will he be able to identify the correct therapy to be adopted. Treatments can be pharmacological, outpatient or surgical.


The remedies and therapies to treat and alleviate the symptoms caused by internal hemorrhoids can be of various kinds and will depend on the type of hemorrhoidal disease and above all on its severity. Based on these elements of evaluation, treatments against hemorrhoids can be easily divided into three categories:

Medical therapies: the attending physician could arrange a targeted drug therapy for topical use (applied directly to the area to be treated) or oral. The first type of drug, which includes suppositories, creams and oils, aims to reduce the discomfort associated with burning and bleeding. Most of these products are cortisone-based and therefore perform a sort of anesthetic function on pain. Therapies with drugs for local use are recommended for periods of time not exceeding a few days. Instead, they should be avoided during pregnancy. Also, in the presence of bleeding internal hemorrhoids, cortisone may help delay healing. In these cases, it is advisable to use cortisone-free drugs.
If the therapy based on topical drugs is not suitable, it is possible to resort to products for oral use. There are various categories of products in this regard. Some of these require a prescription, while others can be freely purchased at the pharmacy. However, it is always advisable to follow the instructions of your doctor. Medicines for oral use usually contain elements that allow them to perform the so-called protective capillary function. This means that they can also be used in the presence of bleeding episodes;

Surgical treatment: a surgical operation is used in all cases in which internal hemorrhoids occur in the third or fourth degree. The goal, in these cases, is to resize the hemorrhoids. Depending on the severity and size of the latter, there are different surgical treatments that can be implemented such as elastic ligation, hemorrhoidectomy, laser therapy or sclerotherapy;

Natural remedies: Treatment of internal hemorrhoids is relatively simpler than that of external hemorrhoids. There are therefore a long series of natural remedies and daily precautions that can be applied to relieve the symptoms of hemorrhoids. The first remedy is to use extremely delicate neutral soaps and detergents, in order to cleanse the anal area in a non-aggressive way. It is also recommended to modify your daily diet, favoring the intake of foods rich in fiber such as vegetables and cereals.

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