What are the other Names for this Condition? (Also known as/Synonyms)

• IH (Internal Hemorrhoids)
• Rectal Lump

What is Internal Hemorrhoids? (Definition/Background Information)

• Internal Hemorrhoids (IH) are swollen blood vessels within the rectum or anal canal that can occur due to increased pressure in the lower rectum. This pressure may result from straining during bowel movements, chronic constipation or diarrhea, obesity, and pregnancy
• Internal Hemorrhoids are often painless and may not cause noticeable symptoms. However, they can lead to bleeding during bowel movements, and in some cases, they may prolapse or protrude outside the anus, causing discomfort or irritation
• Treatment for Internal Hemorrhoids includes lifestyle changes such as dietary modifications to increase fiber intake, drinking plenty of water, and avoiding prolonged sitting. Over-the-counter creams and suppositories may help relieve symptoms. More severe cases might require procedures like rubber band ligation or sclerotherapy
• Preventive measures include maintaining a healthy diet, regular exercise, and practicing good bowel habits. The prognosis of Internal Hemorrhoids is generally favorable with appropriate management, but persistent or severe symptoms should prompt a healthcare professional evaluation for tailored advice and treatment

There are various types of hemorrhoids, and these include:

• Internal Hemorrhoids: These are present far inside the rectum and are not typically visible from the outside. They rarely cause pain but can cause bleeding
• External Hemorrhoids: These are present underneath the anal skin and can lead to thrombosis or blood clot in the veins, which appears as a hard lump around the anus
• Mixed Hemorrhoids: These result from vascular issues in the lower rectum, causing lumps due to pathological dilation. They exhibit features of both internal and external hemorrhoids

Who gets Internal Hemorrhoids? (Age and Sex Distribution)

• Individuals between the age group of 20 and 50 are susceptible to External Hemorrhoids
• The condition may be noted in both males and females
• Worldwide, individuals belonging to any racial or ethnic group may be affected

What are the Risk Factors for Internal Hemorrhoids? (Predisposing Factors)

The following factors increase the risk for Internal Hemorrhoids:

• Individuals who have a diet that is high in processed food are at risk for contracting hemorrhoids
• Straining during bowel movements
• Undesirable bowel habits such as sitting in the toilet for long hours
• Pregnancy
• Aging
• Chronic constipation
• Diarrhea
• Anal intercourse
• Cirrhosis
• Obesity or excess body weight
• A diet containing high-fat and low-fiber food

It is important to note that having a risk factor does not mean one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Internal Hemorrhoids? (Etiology)

Swollen blood vessels found inside the rectal canal are termed Internal Hemorrhoids. These hemorrhoids develop due to increased pressure within the rectum and anal canal. Several factors contribute to this increased pressure, leading to their formation.

The common causes include:

• Overweight or obesity
• Pregnancy
• Cirrhosis
• Sitting in one place for a long time, especially in the toilet
• Straining   during bowel movements
• Anal intercourse
• Diarrhea
• Colon cancer
• Holding breath during physical labor
• Individuals who have a low-fiber diet with less fluid intake may be prone to constipation, which can lead to hemorrhoids

What are the Signs and Symptoms of Internal Hemorrhoids?

The common signs and symptoms associated with Internal Hemorrhoids include:

• A lump or swelling near the anus, which is both sensitive and painful
• Anal itching
• Anal mucus discharge
• Blood in stool; bleeding during bowel movements
• Fullness of the rectum
• Feeling of unfinished defecation
• Protruding hemorrhoids from the anus
• Frequent urge to pass stools immediately after a bowel movement
• Leakage of feces
• Rectal pain, which can be severe
• Discomfort
• Irritation of the rectal skin
• Internal Hemorrhoids can prolapse

Generally, since these hemorrhoids occur inside the rectum, they may not be felt.

How is Internal Hemorrhoids Diagnosed?

  The diagnosis of Internal Hemorrhoids may involve the following tests and procedures:

• A thorough follow-up of the medical history of the patient
• A complete physical examination to check for all the signs and symptoms exhibited by the patient
  • The physician may insert a gloved finger into the anus to touch and feel the swollen blood vessels
  • A short plastic tube with light at its tip, called an anoscope, is inserted into the anus to visualize the Internal Hemorrhoids
• The physician may use a proctoscope for a complete rectal examination
• Sigmoidoscopy and colonoscopy procedures may be undertaken to rule out other colon and rectal conditions

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Internal Hemorrhoids?

The following are the potential complications that can result from Internal hemorrhoids:

• Appearance of a bluish-colored painful lump protruding outside the anus
• Severe or prolonged bleeding
• Severe discomfort

How is Internal Hemorrhoids Treated?

Treatment and management of Internal Hemorrhoids will depend on the extent and severity of the condition. The various procedures adopted for the treatment of Internal Hemorrhoids include:

• Rubber band ligation:
  • When the degree of the inflammation is small, this method is adopted
  • An elastic band is placed at the base of the internal hemorrhoids to cut off the blood supply
  • Stopping the blood supply will cause the hemorrhoid to contract and eventually fall off after a week
• Sclerotherapy:
  • Recommended for first and second-level hemorrhoids
  • A chemical is injected into the base of the hemorrhoids to cut off the blood supply, which hardens the tissue
• Infrared coagulation:
  • A non-surgical procedure to treat small and medium-sized hemorrhoids
  • The hemorrhoids are exposed to infrared light, which leads to scarring of the hemorrhoids and reduced blood flow to the hemorrhoids, ultimately leading to the fall of the hemorrhoids
• Laser coagulation:
  • Electric current is used for the treatment of hemorrhoids
  • Electric current will stop blood flow to the hemorrhoids and help reduce their size
• Hemorrhoidectomy:
  • Surgical removal of the hemorrhoids. It is used only in severe cases
  • Under this procedure, the hemorrhoids are cut off, and the wound is cleaned up and protected using antibiotic ointment and gauze

How can Internal Hemorrhoids be Prevented?

The following measures may be adopted to prevent Internal Hemorrhoids:

• Making the stool soft so it passes out quickly without too much strain and stress
• Emptying the bowel immediately when the urge occurs
• Regular exercises and walking
• Increasing fiber content in the diet will help reduce constipation and, in turn, prevent hemorrhoids

What is the Prognosis of Internal Hemorrhoids? (Outcomes/Resolutions)

The prognosis for Internal Hemorrhoids is generally favorable with appropriate management.

• Lifestyle changes, dietary modifications, and medical treatments can help alleviate symptoms
• In most cases, hemorrhoids do not cause serious complications, and symptoms can be effectively managed

Additional and Relevant Useful Information for Internal Hemorrhoids:

The following DoveMed website link is a helpful resource for additional information:

https://www.dovemed.com/health-topics/focused-health-topics/hemorrhoidectomy-surgical-treatment-hemorrhoids