Foods To Avoid With Hemorrhoids For Faster Relief

Internal Hemorrhoids: Grades, Symptoms, and Treatment Options

Internal hemorrhoids are swollen veins located inside the rectum, often unnoticed until they cause bleeding or discomfort. Unlike external hemorrhoids, which are visible around the anus, internal hemorrhoids develop higher in the anal canal. While they may initially be painless, ignoring them can lead to complications such as prolapse or thrombosis. Understanding the causes, symptoms, and treatment options is essential for effective management.

Diagram showing internal hemorrhoids in the rectum

Understanding Internal Hemorrhoids

Internal hemorrhoids are vascular cushions inside the rectum made of blood vessels, connective tissue, and smooth muscle. Normally, these cushions help with stool control, but when the veins become swollen or inflamed, they turn into hemorrhoids. They are classified into four grades based on severity:

  • Grade 1: Swelling remains inside the rectum, often asymptomatic.
  • Grade 2: Hemorrhoids prolapse during bowel movements but retract spontaneously.
  • Grade 3: Hemorrhoids prolapse and require manual repositioning.
  • Grade 4: Hemorrhoids are permanently prolapsed and may be thrombosed, often causing pain.

Internal hemorrhoids form from dilation of the superior rectal veins, and the rectal venous cushions are especially prone to swelling due to their structural composition and constant exposure to pressure changes. For a broader understanding of hemorrhoid types, visit our Types of Hemorrhoids cluster page.

Causes of Internal Hemorrhoids

The main cause of internal hemorrhoids is increased pressure in the lower rectum, which weakens and stretches the rectal veins. Common contributing factors include:

  • Chronic Constipation or Straining: Repeated straining increases pressure on rectal veins, causing swelling and prolapse. (Learn more about constipation as a cause)
  • Pregnancy: Increased pelvic pressure from the growing uterus and hormonal changes can enlarge rectal veins. (Hemorrhoids during pregnancy)
  • Low-Fiber Diet: Diets lacking fiber can lead to hard stools and straining. A high-fiber diet softens stools, making them easier to pass. (High-fiber diet for prevention)
  • Obesity: Excess weight increases pressure on pelvic veins, elevating hemorrhoid risk. (Obesity and hemorrhoid risk)
  • Prolonged Sitting: Sitting for long periods, especially on the toilet, increases rectal pressure.
  • Chronic Diarrhea: Frequent loose stools can irritate rectal tissue, contributing to hemorrhoid development. (Chronic diarrhea and hemorrhoids)
  • Heavy Lifting: Strenuous lifting increases intra-abdominal pressure, affecting rectal veins. (Heavy lifting as a risk factor)

These factors explain why certain populations, such as pregnant women, the elderly, and individuals with sedentary lifestyles, are more prone to developing internal hemorrhoids.

Symptoms to Watch For

Internal hemorrhoids often remain painless because they are located above the dentate line in the rectum, where there are fewer pain-sensing nerves. This explains why many people do not realize they have internal hemorrhoids until bleeding or prolapse occurs. Common symptoms include:

  • Bright red blood on toilet paper or in the toilet bowl
  • Occasional itching or irritation in the anal region (Hemorrhoid-related itching)
  • A feeling of incomplete bowel evacuation
  • Prolapse: hemorrhoids protruding from the anus, which may require manual repositioning
  • Mucus discharge that can stain underwear (Learn more about mucus discharge)

Subtle symptoms are often overlooked, making routine awareness of bowel habits and stool changes critical. Severe bleeding or pain may indicate complications or other colorectal conditions, so prompt evaluation is recommended. For a more complete overview, see our Symptoms & Diagnosis cluster.

Diagnosis of Internal Hemorrhoids

Because internal hemorrhoids are not visible externally, doctors use specific diagnostic methods:

  • Digital Rectal Exam: A gloved finger is inserted into the rectum to detect swelling, tenderness, or irregularities.
  • Anoscopy: A small, lighted tube allows direct visualization of internal hemorrhoids.
  • Proctoscopy or Sigmoidoscopy: Used if there is significant bleeding to evaluate the rectum and lower colon.

Proper diagnosis ensures internal hemorrhoids are distinguished from other conditions like colorectal polyps, fissures, or cancer. Detailed guidelines can be found at the Mayo Clinic.

Treatment Options

Treatment depends on severity, ranging from lifestyle changes to medical procedures.

1. Lifestyle and Home Remedies

Many mild internal hemorrhoids respond well to home management:

  • High-Fiber Diet: Fruits, vegetables, legumes, and whole grains prevent constipation. Both soluble and insoluble fibers are beneficial. (See our fiber diet guide)
  • Hydration: Adequate water intake softens stools.
  • Sitz Baths: Warm baths 10–15 minutes daily reduce inflammation and soothe discomfort. (Learn how to do a sitz bath)
  • Topical Treatments: Over-the-counter creams can relieve irritation and swelling. (OTC hemorrhoid creams)
  • Fiber Supplements: Psyllium or methylcellulose can help achieve daily fiber goals.
  • Proper Toilet Habits: Avoid prolonged sitting or straining; use a squatty posture to reduce anal pressure.
  • Regular Exercise: Walking or pelvic floor exercises improve circulation and prevent constipation.

2. Medical Procedures

If home remedies are insufficient, minimally invasive or surgical options are available:

Prevention and Long-Term Care

Preventing recurrence involves consistent bowel health practices and monitoring early signs of hemorrhoid development:

  • Maintain a fiber-rich diet and stay hydrated
  • Exercise regularly to improve circulation
  • Practice proper toilet habits, avoid straining, and limit sitting time on the toilet
  • Manage weight to reduce pelvic pressure
  • Monitor bowel habits and stool consistency for early intervention
  • Seek medical advice promptly if symptoms worsen or persist

For more long-term strategies, see our Diet & Prevention cluster page.

When to See a Doctor

Consult a healthcare provider if you experience:

  • Heavy or persistent rectal bleeding
  • Severe pain or prolapsed hemorrhoids that cannot be repositioned
  • Signs of infection, including swelling, redness, or fever
  • Unexplained changes in bowel habits

Most internal hemorrhoids are manageable with conservative measures, but early detection and proper care are key to preventing complications. For more information, visit our Types of Hemorrhoids cluster page.

Internal hemorrhoids prevention and treatment tips