Internal hemorrhoids

what are internal hemorrhoids

What are internal hemorrhoids?

When we say hemorrhoids we usually think of another name for them – piles. These words associate us with a persistent and above all unpleasant disease of the final part of the digestive tract – hemorrhoidal disease.

Hemorrhoids themselves do not always represent a state of disease but it is a normal structure of the final part of the colon and anus which has the function of preserving continence, ie to keep gas and liquid stools and finally to protect the upper part of the anal canal from mechanical injuries.

Veins and arteries are directly connected in hemorrhoids and when hemorrhoidal disease occurs due to various circumstances the blood vessels in this place swell and depending on the severity, ie the level of hemorrhoid disease these nodules can be more or less pronounced.

Although there are written traces that Hippocrates treated hemorrhoids in ancient times hemorrhoidal disease is considered a modern health problem primarily due to the lifestyle of today’s man which often involves sitting, poor or inadequate diet with little fiber to aid digestion, minimal physical activity or its complete absence, as well as numerous bad habits one of which is a long sitting on the toilet.

There are assumptions that every other person over the age of 30 has some negative experience with hemorrhoids and that the number of people with symptoms of hemorrhoids is constantly increasing.

However as dramatic as the statistics are the real situation in the general population can be even worse because the problem with hemorrhoids is experienced by many people personally and they often try to solve this problem on their own or with the help of various tips to avoid going to the doctor.

We don’t have to spend a lot of words to explain that this health problem even when it has not reached the stage when it endangers life (which can last for years) affects the complete quality of life.

Before we explain internal hemorrhoids it is important to briefly distinguish between internal and external hemorrhoids.

What separates them is the jagged line that is 1.5-2 cm from the anal edge.

Hemorrhoids above that line are internal and below it are external.

External hemorrhoids can rearly be confused with any other health problem.

In addition to itching at the entrance to the anus pain is often one of the symptoms as well as the appearance of bloody marks in the stool but also on the laundry and after the usual personal hygiene.

Hemorrhoids are swollen and painful and can be felt by hand.

In internal hemorrhoids this palpation is possible only in the advanced stages of untreated or incorrectly treated hemorrhoids which have therefore grown and protruded at the entrance to the anus.

Blood in itself always looks dramatic and in the end it is not good to encourage people not to worry about this appearance.

Any such change should be reported to the doctor as soon as possible who will further conduct the necessary tests and determine whether it is internal hemorrhoids or some other health problem.

Unfortunately these other health problems are primarily malignant diseases of the final part of the colon.

That is why it is important that all patients with symptoms of hemorrhoidal disease or any problems that resemble them do a digital rectal examination and endoscopic examination and in those older than 50 years a colonoscopy.


Internal hemorrhoids are classified into four degrees depending on how advanced the disease is:

First degree internal hemorrhoids

In the first degree, the hemorrhoids are slightly enlarged, they are not visible from the outside and can be shown through mild bleeding, but they can pass without this symptom. Accordingly, in most cases, this degree of hemorrhoidal disease of internal hemorrhoids does not require surgical treatment.

Second degree internal hemorrhoids

In the second degree, internal hemorrhoids come out through the anal canal during defecation or some heavy physical effort. Hemorrhoids that come out in this way do not return spontaneously and usually require a manual return procedure. Hemorrhoids of the second degree can manifest as small nodules the size of a clicker, which appear after a large emergency, but also save themselves. This stage of hemorrhoidal disease sometimes requires surgery.

Third degree internal hemorrhoids

The third degree implies that larger hemorrhoids come out through the anal canal, but they return spontaneously. They can be clicker sizes, but they can also be larger, they can be one or more enlarged. They don’t necessarily have to be very painful. Sometimes you can return them by hand through the anal canal, sometimes not and in most cases they require clinical treatment.

Fourth degree internal hemorrhoids

The fourth degree most often occurs with perennial hemorrhoidal disease that has not been treated at all or has not been treated adequately. Here the hemorrhoids have fallen out so much that they cannot return, either spontaneously or manually. It is characteristic that hemorrhoids of the fourth degree are as big as strawberries or even bigger than that. They often bleed and are painful and surgery is necessary at this stage of the disease.


As we said in the definition the symptoms depend primarily on the degree of progression of the disease.

You can even ignore internal hemorrhoids in the first degree and even some spotting that can occur at this stage of the disease can be overlooked.

But that is only the beginning.

Later even in the first degree the discomfort caused by hemorrhoidal disease they begin to warn us to pay attention to our health.

This disease can be manifested by various symptoms that are similar to the symptoms of other diseases in the anal and perianal region.

It is very important that you tell your doctor if you notice any of the following symptoms:

  • swelling, itching and pain in the anal region especially pain in the anal region during an emergency. The feeling of itching and tingling can be extremely unpleasant and the pain can be of varying intensity so each visit to the toilet can be a torture in itself.
  • the appearance of blood on the toilet paper which can be experienced more dramatically than the previous inconveniences occurs after a defecating. The most common cause is solid stool that damage the thin walls of blood vessels in hemorrhoids. Bleeding can be spotty and almost imperceptible but it can also burst on the surface of the toilet bowl which can really scare patients.


The causes of hemorrhoids are really numerous.

Somehow, they are all connected with the modern way of life, which implies a lack or absence of physical activity, sitting at the computer, behind the wheel or on any other occasion.

Sitting is actually the cause of increased pressure on the anal area which causes the appearance of hemorrhoidal problems.

The cause of hemorrhoids is also a type of diet that does not meet the basic nutritional principles, especially those low in fiber which are important for good digestion.

Finally, obesity as one of the leading diseases of modern man can cause internal hemorrhoids and genetic predisposition is often mentioned as an important factor.

In addition, anal infections or any irritation of the anal region can lead to internal hemorrhoids.

Here, it is important to point out chronic constipation which is related to all previous causes.

Internal hemorrhoids are an almost inevitable consequence of chronic constipation.

Problems with internal hemorrhoids are a common companion of pregnancy and can occur both during pregnancy and after it due to the great pressure with which the fetus affects the anal part of the colon.

Even when the pregnancy passes without this really hard phenomenon, vaginal childbirth itself can cause the appearance of hemorrhoids due to high stresses and pressure on the anus.

Hemorrhoids that occur during pregnancy and vaginal childbirth can eventually go away on their own or after milder forms of treatment with ointments or herbal preparations but they can remain as a consequence that women struggle with.

The appearance of internal hemorrhoids is more noticeable in men especially those who are engaged in heavy physical work that involves carrying a large load as well as professional drivers who spend most of the day in a sitting position behind the wheel.

It is especially important to point out for those who like reading books in the toilet that sitting on the toilet for too long can cause the appearance of hemorrhoidal disease.


Unfortunately, pain is usually the only reason why patients call a doctor. We believe that you all know this is a well-known practice of taking care of your own health no matter what the problem.

With internal hemorrhoids pain does not have to be the first indicator and we certainly should not wait for its intensity to increase and only then turn to professional help.

Unpleasant itching and tingling are among the first indicators that something is wrong in the anal part of the colon.

The pain in the first stage of the problem with internal hemorrhoids does not have to be pronounced but already in the third and fourth stage they represent a serious discomfort.

This is also the moment when it is certain that surgery is needed to cure it.


According to some researches, more than fifty percent of the population today has a problem with hemorrhoids and it is estimated that this number is even higher considering that a large number of people who have this health problem do not seek medical help for a long time or try to solve it on their own.

Very often, in the process of home treatment methods of treatment with medicinal herbs and medicines made from ingredients that can be found in almost every home are applied.

Experiences after such treatment can be positive in the first stages of internal hemorrhoids.

However here is also important to rely on the advice of good connoisseurs of medicinal herbs and balms or on natural preparations whose manufacturers are known for making effective medicines based on medicinal herbs.

As for medicines, compresses and suppositories that you can make at home the most commonly used ingredients are:

  • raw potatoes
  • aloe vera in combination with homemade honey and butter
  • chamomile tea
  • nettle tea
  • garlic
  • honey
  • cocoa
  • butter
  • plantago

It is possible to find recipes for making suppositories on the Internet that alleviate the symptoms of internal hemorrhoids.

People who have used various creams to treat hemorrhoids also share their experiences which vary from the degree of the disease to the individual reaction of each patient to individual treatments.

One of the products that is often mentioned as very effective is Flogocid ointment.

This is an ointment that could only be bought in a veterinary pharmacy for a long time but today it is available in every human pharmacy.


It is really important to point out that the disease of internal hemorrhoids is a health problem like any other.

Unpleasant in itself and certainly a problem that requires a medical examination that no one likes but it is important to be aware that only in a few cases of hemorrhoids can be treated with the advice of a pharmacist or a connoisseur of traditional medicines if the hemorrhoids are in an advanced stage.

Due to the possibility of disease progression and complications that may occur due to inadequate treatment it is very important to consult a doctor immediately after noticing the first symptoms.

This is very important with internal hemorrhoids, even more than with external hemorrhoids, because the problem with internal hemorrhoids can deceive far more dangerous diseases that can be successfully stopped only with timely therapy.

Indeed, shame or procrastination should not be a reason to endanger our own health at a time when we can help ourselves.

The diagnosis of hemorrhoidal disease is made by physical examination and it includes digitorectal examination and anoscopic examination.

In this way the degree of the disease and the method of treatment are determined.

The problem with internal hemorrhoids can be solved non-surgically because it is not a practice to treat every form of the disease with surgery.

This type of treatment implies a change in life and eating habits, but also the introduction of specific therapy which can completely eliminate the need for surgical intervention, of course only if you call the doctor on time.

Non-surgical treatment involves the use of topical ointments and creams, certain drugs that reduce blood flow through hemorrhoids and mandatory dietary changes that include intake of more fluids (about 2.5 liters per day) and foods rich in fiber that have a positive effect on the digestive tract.

When non-surgical methods do not give results or are not effective due to the advanced stage of the disease, surgical methods are applied.

Classical surgical methods involve the removal of hemorrhoidal nodules and their ligation in typical places with the use of total anesthesia.

There is a risk of complications such as prolonged and difficult recovery, pain after the operation can last for weeks, damage to the sphincter, narrowing of the anus, etc.

Modern methods are performed under short-term anesthesia, they are minimally painful and patients recover in a day or two.

Of the modern methods the “Ligasure” method is known, which performs radiofrequency coagulation of dilated blood vessels with the help of a “Ligasure” device. Laser hemorrhoid plastic surgery is also known, which involves laser sclerosis of varicose hemorrhoidal veins. Both methods require quick recovery.

The most modern method of treatment is the operation of hemorrhoids with the THD method, which directly affects the very cause of hemorrhoids without an incision. With this target, they are permanently solved.