Internal Hemorrhoids: Causes, Symptoms, Treatment, and Cost

Veins within the rectum and anus that are inflamed are known as internal haemorrhoids. They might be extremely minute, isolated patches of inflammation, or bigger, clumped-together clusters. Since internal haemorrhoids may bleed, they are often mistaken for external haemorrhoids.

Internal Hemorrhoids can be classified into four types:

• Grade 1 Internal Hemorrhoids: These are small and they usually bleed when the tissue is damaged. They may not protrude outside the anus and will usually resolve on their own with proper care.
• Grade 2 Internal Hemorrhoids: These are large enough to become a lump that extends out of the anus when you strain to pass a bowel movement. They may need treatment to become smaller and resolve themselves, but they often can protrude back into the rectum on their own with proper care.
• Grade 3 Internal Hemorrhoids: These are very large and require manual manipulation for them to go back inside the anus after being expelled outside of it during a bowel movement or other straining activity.
• Grade 4 Internal Hemorrhoids: Grade 4 Internal Hemorrhoids refer to hemorrhoids that have prolapsed, which means they have dropped down from their normal position and cannot be pushed back inside. Grade 4 Internal Hemorrhoids are the most severe type of internal hemorrhoid and often cause significant discomfort and bleeding.

Internal Hemorrhoids may be caused by:

• Constipation: When stools are hard and dry, the extra effort needed to pass them can cause extra pressure on the rectal veins which leads to Internal Hemorrhoids.
• Improper diet: A lack of fiber, drinking too much alcohol and caffeine, and eating processed foods can lead to constipation and increase the risk of Internal Hemorrhoids.
• Pregnancy: Internal haemorrhoids in pregnant women are caused by the pressure the expanding uterus imposes on the rectal veins.
• Genetics: A weak rectal vein wall or an inherited predisposition could be a potential cause of developing Internal Hemorrhoids.
• Obesity: Excess weight puts more strain on veins, which may lead to an increased risk for Internal Hemorrhoids.

These are common symptoms of Internal Hemorrhoids:

• bleeding that is painless during bowel motions.
• Vivid crimson blood on toilet paper, in the squat, or the bowl.
• the feeling of satiety in the anus or rectum.
• A bulge or lump near the anus that may become painful and throbbing.
• Discomfort with sitting due to pressure on the rectum.
• Anal itching and/or soreness.

Here are some ways to prevent Internal Hemorrhoids:

• Maintain a healthy weight.
• Eat a diet rich in fiber.
• Drink plenty of fluids.
• Exercise regularly.
• Avoid straining during bowel movement.
• Take time to relax and reduce stress.

These tests may be done to diagnose Internal Hemorrhoids:

• Physical examination: This involves inspecting the anus, feeling for any bumps, lumps, or swelling around the anus, and looking inside the anus with a short metal tube for visual inspection.
• Anoscopy: This procedure involves inserting an anoscope (short metal tube) into the anal canal to view Internal Hemorrhoids.
• Proctoscopy: This procedure involves passing a proctoscope (a long metal tube) into the rectum and lower colon to detect any hemorrhoidal closeness or damage.
• Proctography or Defecography: This test involves taking x-ray images of the rectum after examining it with injected dye to better identify any problems with Internal Hemorrhoids, such as narrowing of the anal canal.
• Sigmoidoscopy: If a doctor suspects that there may be complications in other areas of your digestive tract, he/she may recommend undergoing this test which a sigmoidoscope (longer metal tube) is inserted into your rectum and lower colon to view them more closely.
• Blood tests: These tests may be ordered by a doctor to determine if any underlying health conditions may be causing Internal Hemorrhoids, such as high blood pressure or diabetes.
• Stool sample tests: These will help identify infection-causing bacteria in your stool that could be contributing to your internal hemorrhoid problem.

Several conditions might develop as a result of internal hemorrhoids:

• Bleeding: Internal haemorrhoids may result in painless bleeding when urinating.
• Prolapse: Protrusion of hemorrhoid from the rectum, which may require manual reduction.
• Thrombosed Hemorrhoid: A blood clot can form in the vein providing an acutely painful swelling and hard lump around the anus that goes away with time or with medical treatment.
• Infection: Prolapsed parts of tissue may become infected, which would require antibiotic therapy to treat it appropriately.
• Mucous Discharge: It might lead to the soiling of underwear which may be difficult to clean up and cause discomfort or itching sensation in the anal area.

Here are some home remedies for treating Internal Hemorrhoids:

• Boil some guava leaves in water and consume the solution twice a day.
• Drink buttermilk mixed with 1/2 tsp of coriander powder to relieve inflammation.
• Apply coconut oil to the affected area.
• Warm water with psyllium husk (Espanol) added should be consumed first thing in the morning.
• For 15 minutes, apply a cold compress to the afflicted region to reduce swelling.
• Witch hazel paste can be applied over the affected area two times daily.

Foods to eat in Internal Hemorrhoids include:

• High-fiber foods: Eating plenty of high-fiber foods, such as fruits, vegetables, legumes (beans and peas), and whole grains can help soften stools, control bowel movements, and prevent straining during a bowel movement.
• Consuming enough water will avoid you from being dehydrated and keep your feces soft so they can easily travel through your anus. The greatest liquid to consume while experiencing hemorrhoids is water.
• Consume probiotics: By returning healthy bacteria to the digestive system and assisting in the promotion of appropriate digestion, probiotics—beneficial bacteria that can be found in yogurt and other fermented foods—may help alleviate the symptoms of haemorrhoids.

One should avoid consuming these foods in Internal Hemorrhoids:

• Spicy foods: Eating spicy foods can aggravate the symptoms of Internal Hemorrhoids, causing pain and inflammation.
• High-fat foods: High-fat foods can cause constipation and make it difficult for the digestive system to effectively process waste, which can irritate hemorrhoids.
• Caffeine: Caffeine has a laxative effect on the body, making it hard for the digestive system to process waste and leading to irritation of hemorrhoids.
• Alcohol: Alcohol has been linked to dehydration and inactivity, both of which are risk factors for developing Internal Hemorrhoids.
• Refined grains: Eating refined grains like white bread and pastas can lead to constipation due to their lack of dietary fiber.

Internal hemorrhoids may be treated using the following methods:

• Take a warm bath: Taking a warm bath or soaking in a sitz bath can help to soothe irritated tissues and reduce inflammation of the affected area.
• Apply a topical medication: Over-the-counter topical hemorrhoid creams, ointments, or suppositories can help relieve symptoms by providing temporary relief from itching and burning sensations associated with Internal Hemorrhoids.
• Use medicated wipes: Using medicated wipes, such as those formulated with witch hazel, may also provide added symptom relief of burning, itching, pain, and discomfort associated with Internal Hemorrhoids.
• Rubber band ligation: In order to stop the flow of blood to an internal haemorrhoid, a doctor wraps a specific rubber band around its base. After a few days, the haemorrhoid diminishes and comes off.
• Sclerotherapy: This technique is a solution injected into the swollen veins at the lower end of the rectum, shrinking them and relieving discomfort, itching, and bleeding.
• Hemorrhoidectomy: This surgical procedure removes tissue to relieve severe pain and bleeding in the rectum.
• Cryotherapy: In this procedure, doctors use liquid nitrogen to freeze and destroy hemorrhoidal tissue, eventually causing it to slough off over several days or weeks.
• Laser therapy: During this technique, a doctor uses laser light to obliterate enlarged veins associated with Internal Hemorrhoids, causing inflammation that stimulates the growth of healthy new veins in place of enlarged vessels that shrink away over several weeks or months after treatment

A person with Internal Hemorrhoids should seek consultation from a doctor specializing in gastrointestinal issues to receive a proper diagnosis and treatment. Common specialist doctors include general practitioners, gastroenterologists, and proctologists.

Common medicines used in the treatment of Internal Hemorrhoids are:

• Steroid medications: These topical medications can help reduce irritation and itching caused by Internal Hemorrhoids. Examples include hydrocortisone cream, suppositories, and foams such as Proctozone-H or Cortifoam.
• Stool softeners: These are used to soften stools, which makes them easier to pass and helps reduce the risk of further damage to the affected area in the rectum caused by straining during a bowel movement. Examples include Colace or Senna-S tablets/suppositories/bulk laxatives.
• Pain medications: Pain relievers such as ibuprofen may be used to help ease discomfort associated with Internal Hemorrhoids flare-ups, though this should always be discussed with a doctor first before taking any medication on your own as some painkillers can have serious side effects if not prescribed properly by a professional doctor or pharmacist for your specific situation or condition.
• Anti-inflammatory Medications: Ibuprofen and other non-steroidal anti-inflammatory medicines (NSAIDs) may assist with internal hemorrhoids by easing discomfort and swelling.

Internal hemorrhoids often need a period of recuperation depending on the severity of the condition and the chosen treatment strategy. However, most people can expect to recover within a few days to a few weeks.

The effectiveness of treatment for Internal Hemorrhoids depends largely on the severity and type of hemorrhoid. Some treatments can provide relief from symptoms such as pain and itching, however, these results may not be permanent. Certain treatments may provide more long-term relief, such as surgical treatment or band ligation, but recurrence is possible.

After treatment, it is important to follow certain guidelines to reduce the chances of recurrence and to heal faster.

• Follow a high-fiber diet with plenty of fluids.
• Take oral pain relief medication, as prescribed by your doctor.
• Steer clear of bending over, straining, and prolonged sitting.
• Avoid eating anything hot or acidic, as well as alcohol and caffeine.
• Apply cold compresses to the area to reduce swelling and discomfort following bowel movements and sitz baths to help soothe hemorrhoid tissue after bowel movements.
• Discuss options for topical creams, if needed, with your physician for advanced treatment of symptoms such as hemorrhoidal burning or itching sensation caused by Internal Hemorrhoids if other treatments are ineffective.

Depending on the kind of therapy selected and the severity of the illness, internal hemorrhoid treatments in India vary in price. Generally, conservative treatments such as dietary changes, lifestyle modifications, and non-surgical interventions such as rubber band ligation or sclerosis therapy may range from ₹500 to ₹2000. Surgical treatments may cost between ₹8000 to ₹25000.

Common side effects of treatments for Internal Hemorrhoids include:

• Pain: Discomfort and pain along with itching, in the case of thrombosed hemorrhoids can happen.
• Bleeding: Rectal bleeding is common during the early stages of the treatment.
• Itching: Temporary itching sensation around the treated area may be experienced by patients.
• Infection: Infection is rare but can occur in some cases after treatment if proper hygienic steps are not taken care of or due to an allergic reaction to some medications prescribed by the doctor.
• Skin irritation/ulceration: Due to rubbing or scratching around the anal area, skin irritation or ulcerations are also possible side effects following a hemorrhoid treatment procedure.

Internal hemorrhoids may result in issues such as 'thrombosed hemorrhoid, infection, mucous discharge,' the severity of which will determine how long it will take to cure. If you have any complications related to internal haemorrhoids, you should see a doctor in your area.