Internal haemorrhoids: causes, symptoms and treatments

Internal vs. external haemorrhoids: what’s the difference?

Unlike external haemorrhoids, which can be itchy and painful, internal haemorrhoids usually don’t hurt, because the nerves in the upper part of the anal canal (where they form) are unable to carry pain signals.

Internal haemorrhoids can also be grouped based on factors such as their size and severity, as well as how much they stick out.

When diagnosed, your internal haemorrhoid may be defined as:  

• First degree – the haemorrhoid isn’t visible and stays inside the anus
• Second degree – the haemorrhoid sticks out when you go to the bathroom but then goes back in by itself
• Third degree – the haemorrhoid sticks out when you go to the bathroom and can be manually pushed back in afterwards
• Fourth degree – the haemorrhoid sticks out and you can’t push it back in
   

Symptoms of internal haemorrhoids: what do they look and feel like?

Since internal haemorrhoids develop in the upper two-thirds of the anal canal where the nerves can’t transmit pain messages, they can’t be seen and rarely cause any type of pain.

As such, many people will often not realise they have an internal haemorrhoid until it either exhibits certain symptoms or prolapses (where the haemorrhoid falls through your anus).

Some of the most common symptoms associated with internal haemorrhoids can include:

• Bright red blood in your stool, on toilet paper or in the toilet bowl after visiting the toilet
• Prolapse
• An itching or burning sensation
• Swelling
• Difficulties maintaining anal hygiene
• Pain caused due to itching, burning or discomfort

As internal haemorrhoids develop inside of the body, a doctor can diagnose whether you have one using either a digital rectal examination or a proctoscopy. If you’re concerned or would like further support on any symptoms you’re experiencing, speak to your doctor for advice.

Causes of internal haemorrhoids

It’s difficult to know how common internal haemorrhoids are because only a small percentage of affected people seek medical attention for them. As such, little remains known about what causes them to develop.

That said, however, many medical experts believe that both external and internal haemorrhoids develop when there’s too much pressure on the veins located around the bottom. The reasons for the added pressure in this area may include:

• Constipation
• Pushing too hard when pooing
• Heavy lifting
• Having a chronic cough
• Maintaining a low-fibre diet

Being pregnant may also increase your risk of developing internal haemorrhoids due to the growing pressure inside your abdomen and the hormonal changes you go through. It’s important to seek personalised advice from your doctor when dealing with haemorrhoids during pregnancy and ensure any treatments you use are suitable.*

Complications of internal haemorrhoids

Most cases of internal haemorrhoids get better on their own after a few days. But, in some people, they can lead to further issues and complications, including pain and the development of thrombosed or strangulated haemorrhoids.

However, complications can usually be treated using medication or, in some cases, surgery.

If you’re concerned that you might have an internal haemorrhoid, or simply aren’t sure, speak to your doctor.

Internal haemorrhoid treatments

While managing internal haemorrhoids can be uncomfortable, there are a wide range of treatments available to help alleviate your symptoms.

These can be used either at home or as prescribed by a medical professional, and are designed to help ease the symptoms of internal haemorrhoids when they first appear.

Let’s take a look at what you can do to help treat internal haemorrhoids from the comfort of your own home.

Treating internal haemorrhoids at home

By taking a quick trip to your local pharmacy, you’ll discover a wide range of over-the-counter medicines you can use at home to help alleviate your symptoms. These include:

• Creams to ease the pain, itching and swelling
• Treatments to help constipation and soften poo
• Cold packs to ease discomfort

Germoloids® Cream is an over-the-counter cream designed to help combat internal haemorrhoid symptoms.12 Formulated with a local anaesthetic called lidocaine hydrochloride, this product works by helping numb and soothe the area, which can relieve the pain, itching and general discomfort often associated with haemorrhoids.

There are, however, various other types of internal piles treatments you can use, including suppositories (inserted directly into your bottom) and ointments (an oilier alternative to creams). Speak to your pharmacist for advice on which type of treatment is best suited to your needs.

Here’s what you can do to alleviate the symptoms of internal piles:

• Take paracetamol to help relieve pain
• Try not to strain or push too hard when passing stools
• Don’t ignore the urge to poo or spend longer on the toilet than you need to
• Use moist toilet paper to clean your bottom after passing a stool
• Have warm baths to ease itching and pain
• Exercise regularly
• Wrap an ice pack in a towel and apply it to the painful area to ease discomfort
• Keep your bottom clean and dry

It’s also important to consider what you’re eating when trying to avoid internal haemorrhoids. For instance, fibre-rich foods, such as fruits, vegetables, wholegrain rice, wholewheat pasta and bread, pulses and beans, can all help to encourage more regular bowel movements and prevent constipation.

At the same time, cutting down on caffeinated and alcoholic drinks may help to prevent internal haemorrhoids from developing in the future.2 But make sure to drink plenty of fluids, particularly water. 

Internal haemorrhoid treatments by medical professionals

In most cases of internal haemorrhoids, using over-the-counter medications and making both dietary and lifestyle changes should be enough to help relieve your symptoms. But, if you find that they’re either not making a difference or making them worse, speak to your doctor.

Depending on the exact size and severity of the haemorrhoid, as well as the stage it’s progressed to, your doctor may refer you to a specialist for further evaluation. Using a digital rectal examination or a procedure known as a proctoscopy will help them more accurately diagnose the issue and, accordingly, provide you with a tailored treatment plan.

If you’ve found learning about internal haemorrhoids interesting and would like to find out more about their symptoms and causes, check out our tips and advice page which is full of other useful information on the topic.