Internal Hemorrhoids | Causes and Treatment for Rectal Bleeding

What is Internal Hemorrhoids or Piles?

Internal hemorrhoid means it is within the anal canal and internal to the anal orifice. It is covered with mucous membrane and it is bright red or purple in color.

Internal piles usually commence at anorectal ring and ends at the dentate line.

Internal Hemorrhoids Causes

  • Hereditary: It is often seen in members of the same family.
  • Anatomical: Internal piles is a natural consequence of adaptation of erect mankind.
  • Exciting causes: Straining to expel constipated stool causes dilatation of the venous plexus. Over purgation and diarrhea of colitis, dysentery, enteritis etc.
    aggravates latent hemorrhoids.
  • Diet: Low roughage diet may excite hemorrhoid formation.

Secondary hemorrhoids: Piles can be secondary to a few conditions.

Carcinoma of the rectum, pregnancy, chronic constipation, difficulty in urination and portal hypertension are some of the factors.

Symptoms of Internal Hemorrhoids

  • Bleeding: It is the principal and earliest symptom. It is bright red, painless and occurs along with defecation. This may continue for months or even years. As the veins become larger and heavier, partial prolapse will occur with each bowel movement.
  • Prolapse: It is a later symptom. Piles can be divided into four degrees.
    • First degree: Hemorrhoids do not come out of the anus.
    • Second degree: Hemorrhoids come out only during defecation and is reduced spontaneously after defecation.
    • Third degree: Hemorrhoids come out only during defecation and do not return by themselves, but need to be replaced manually and then they stay reduced.
    • Fourth degree: Hemorrhoids here are permanently prolapsed. At this stage great discomfort is complained of with a feeling of heaviness in the rectum.
  • Pain: It is not characteristic unless there is associated thrombosis or there is associated anal fissure.
  • Mucous discharge: It is a particular symptom of prolapsed hemorrhoids, which softens and excoriates the skin at the anus. Anal itching may be present.
  • Anemia: It is often seen in long standing cases of hemorrhoids due to persistent and profuse bleeding.

Complications of Rectal Bleeding

  • Two main complications of hemorrhoids are excessive bleeding and thrombosis.
  • Other rare complications are strangulation of the piles leading to gangrene and fibrosis.

Treatment for Internal Hemorrhoids

  • Injection therapy: Sclerosant injection (5% phenol in almond or arachis oil with 140mg of menthol to make 30ml solution) has been the method of treatment of small vascular hemorrhoids and indeed is used to control all cases of first degree hemorrhoids whatever may be the presenting symptoms.
  • Rubber band ligation: It is an ideal method for treating first degree and second degree piles. Each hemorrhoid is visualized through the proctoscope and is grasped by an instrument and a small elastic band is slipped over it.
  • Cryosurgery: It involves freezing the tissues of the hemorrhoid for sufficient time to cause necrosis. In advanced cases this procedure is of little help.
  • Hemorroidectomy: For large third degree hemorrhoids particularly with associated tags, hemorrhoidectomy is the treatment of choice.
  • Ligature and excision: This is the most widely used operative nowadays. Hemorrhoids are pulled and ligated and hemorrhoids distal to the ligature are excised. Mucous membrane remains are sutured to prevent post-operative stenosis.