How are internal hemorrhoids treated?

Updated: Sep 24, 2019
  • Author: Kyle R Perry, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Internal hemorrhoids do not have cutaneous innervation and can therefore be destroyed without anesthetic, and the treatment may be surgical or nonsurgical. Internal hemorrhoid symptoms often respond to increased fiber and liquid intake and to avoidance of straining and prolonged toilet sitting. Nonoperative therapy works well for symptoms that persist despite the use of conservative therapy. Most nonsurgical procedures currently available are performed in the clinic or ambulatory setting.

The following is a quick summary of treatment for internal hemorrhoids by grade:

  • Grade I hemorrhoids are treated with conservative medical therapy and avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) and spicy or fatty foods

  • Grade II or III hemorrhoids are initially treated with nonsurgical procedures

  • Very symptomatic grade III and grade IV hemorrhoids are best treated with surgical hemorrhoidectomy

  • Treatment of grade IV internal hemorrhoids or any incarcerated or gangrenous tissue requires prompt surgical consultation

Stapled hemorrhoid surgery, or procedure for prolapsing hemorrhoids (PPH), is an excellent alternative for treating internal hemorrhoids that have not been amenable to conservative or nonoperative approaches. Short- and medium-term results are excellent. Patients with minimal external tags and large internal hemorrhoids are easily treated with procedure for prolapsing hemorrhoids and skin tag excision.

In a meta-analysis of randomized, controlled trials, however, Chen et al concluded that the recurrence rate of prolapsing hemorrhoids was higher with stapled hemorrhoidectomy than with LigaSure hemorrhoidectomy. [22] Operative resection is sometimes required to control the symptoms of internal hemorrhoids.


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