Haemorrhoids internal

Overview

Internal haemorrhoids are swollen blood vessels inside the lower part of the rectum (the last part of the large intestine). They often do not cause symptoms, but when they do, they can lead to bleeding, discomfort, or a feeling of fullness in the rectum.

Yes, haemorrhoids affect nearly 3 out of 4 adults at some point in their lives. Internal haemorrhoids are especially common after age 50.

Anyone can develop internal haemorrhoids, but they are more common in adults over 50, pregnant women, and people who sit for long periods or strain during bowel movements.

Symptoms

Common symptoms

• Bright red blood on toilet paper or in the toilet bowl after a bowel movement
• A feeling of fullness or pressure in the rectum
• Mucus discharge
• Itching or irritation around the anus

Symptoms in children

• Internal haemorrhoids are rare in children. If a child has symptoms like bleeding or pain, it is important to see a doctor to rule out other causes.

Symptoms in older adults

• In older adults, symptoms may be milder but bleeding can still occur. Age-related changes in the tissues around the anus make haemorrhoids more likely.

Causes

Main causes

• Increased pressure in the veins of the rectum, often from straining during bowel movements
• Pregnancy and childbirth, which put extra pressure on the pelvic veins
• Chronic constipation or diarrhea
• Aging, as supporting tissues become weaker

Risk factors

• A diet low in fibre
• Obesity
• Prolonged sitting on the toilet
• Heavy lifting or intense physical effort
• Family history of haemorrhoids

When to see a doctor

See a doctor urgently if:

• If you have heavy or persistent bleeding from the rectum
• If you feel dizzy or lightheaded with bleeding
• If you have severe pain that does not improve with home care

Book a routine appointment if:

• If you notice blood in your stool or on toilet paper for the first time
• If symptoms like itching, discomfort, or bleeding do not improve after a week of home care
• If you have a change in bowel habits that lasts more than a few weeks

Diagnosis

A doctor will ask about your symptoms and medical history. They may perform a physical exam to check for internal haemorrhoids.

Tests that may be done

• Digital rectal exam (the doctor inserts a gloved finger into the rectum to feel for haemorrhoids)
• Anoscopy (a small, lighted tube is inserted into the rectum to see the haemorrhoids directly)
• Sometimes a sigmoidoscopy or colonoscopy is recommended to rule out other causes of bleeding

What to expect at your appointment

The exam is quick and usually not painful. You may feel some pressure. Your doctor will explain what they find and discuss the best treatment options for you.

Treatment

Treatment for internal haemorrhoids depends on how severe they are. Many cases improve with lifestyle changes and home care. For more bothersome symptoms, there are medical procedures that can help.

Self-care at home

• Eat more fibre-rich foods such as fruits, vegetables, and whole grains
• Drink plenty of water throughout the day
• Avoid straining when using the toilet
• Take warm baths (sitz baths) for 10–15 minutes a few times a day
• Use gentle, fragrance-free wipes or pat the area dry instead of rubbing

Medical treatments

If home care is not enough, a doctor may suggest over-the-counter creams or suppositories to ease discomfort. For larger or more troublesome haemorrhoids, medical treatments include rubber band ligation (placing a small band around the base of the haemorrhoid to cut off its blood supply), sclerotherapy (injecting a solution to shrink the haemorrhoid), or infrared coagulation. These are done in a clinic and do not usually require an overnight stay.

When is surgery considered?

Surgery is rarely needed, but it may be considered for severe cases that do not respond to other treatments. Surgical options include haemorrhoidectomy (removing the haemorrhoid) or stapling.

Living with this condition

Most people with internal haemorrhoids can go about their normal daily activities. By making simple changes, you can keep symptoms under control and prevent flare-ups.

Lifestyle tips

• Use the toilet as soon as you feel the urge—do not hold it
• Avoid sitting on the toilet for too long
• Stay active with regular exercise like walking or swimming
• If you sit for long periods, take breaks to stand and move around

Diet and exercise

Eating a high-fibre diet and drinking enough fluids can help keep stools soft and reduce straining. Aim for at least 25–30 grams of fibre per day from foods like oats, beans, berries, and leafy greens. Gentle exercise for 20–30 minutes most days can also improve bowel function.

Mental health and emotional wellbeing

Having haemorrhoids can sometimes cause embarrassment or worry, especially if bleeding is involved. It is normal to feel anxious. Remember that haemorrhoids are a common medical condition and nothing to be ashamed of. Talking to your doctor can help ease your fears.

Prevention

While not all cases can be prevented, you can lower your risk by eating a high-fibre diet, drinking plenty of water, exercising regularly, and avoiding long periods of sitting or straining on the toilet.

Complications

If left untreated

• Anaemia (low red blood cells) from chronic blood loss
• Thrombosed haemorrhoid (a blood clot inside the haemorrhoid, causing severe pain)
• Strangulated haemorrhoid (when the blood supply is cut off, leading to severe pain and tissue damage)

Long-term outlook

For most people, internal haemorrhoids improve with simple lifestyle changes and do not lead to long-term problems. Even with more severe cases, treatment is very effective. With proper care, you can manage symptoms and maintain good quality of life.

Find support

International organisations

• World Health Organization (WHO) – Digestive Health

Local organisations

• NHS – Haemorrhoids ↗ · United Kingdom

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