Causes Increased pressure on the rectal veins causes them to enlarge. Internal hemorrhoids are not usually painful, and the only symptom may be minor bleeding noticed during a bowel movement. Bright red blood is seen on the toilet paper, in the water of the toilet bowl or on the stool itself. If the blood is dark red or brown-black in color, it usually is not from a hemorrhoid but from areas higher up in the intestines, or stomach. The itching can be due to irritation from the hemorrhoid or from the anal area not being kept as clean as possible, which can result when one becomes reluctant to vigorously use toilet paper when cleaning the area after a bowel movement because of tenderness.
Diagnosis is made by symptoms, recent history and physical exam.
Treatment Treatment depends on the location and severity of symptoms. One should avoid sitting or standing for long periods of time to reduce the pressure on the rectal veins and avoid straining during a bowel movement. Corrective procedures can be done for prolonged, severe pain, increased bleeding, or symptoms that do not improve with the home care measures. One procedure is called ligation, where a rubber band is placed tightly around an internal hemorrhoid to cut off the circulation, which causes the hemorrhoid to painlessly disappear in a few days. Surgery or a laser procedure also can be performed for removal of large hemorrhoids.