1Which hemorrhoids bleed and when. Should you go to the doctor
Hemorrhoids are vascular structures in the anal canal and lower rectum that act like cushions and help with stool control. The term „hemorrhoid“ is most often used when they are swollen and/or inflamed.
There are internal (in the rectum) and external (around the anal canal) hemorrhoids. It is usually the internal ones that bleed. This can happen in any of their four stages.
External hemorrhoids can also bleed, but less often – mainly when the skin above them is damaged.
Painless bleeding during bowel movement (defecation) is one of the first symptoms of internal hemorrhoids, along with itching and anal discomfort.
External hemorrhoids are usually painful when they thrombose and are felt like lumps around the anus.
Bleeding from hemorrhoids often occurs while straining to have bowel movement, passing hard and dry stools or after heavy physical work.
Read more about the symptoms, causes and stages of external and internal hemorrhoids.
Rectal bleeding due to hemorrhoids has characteristic features that distinguish it from other causes.
- Rectal bleeding that is usually not caused by hemorrhoids:
- Dark reddish-purple blood, pus and mucus – bleeding hemorrhoids lead to the appearance of clear, bright red blood at the end of the bowel movement. The blood is in drops or trickles on the surface of the stool or on the toilet paper. It is not mixed in the stool. If there is pus or dark blood mixed in the stool, it is probably not hemorrhoids.
- Blood on the stool with sharp pain during defecation – often due to anal fissures (tear in lining of the anus). You can have anal fissure and hemorrhoids at the same time.
- Blood in the stool with significant weight loss – hemorrhoids can bleed but do not case significant weight loss. If this is the case, inflammatory bowel diseases (in the young), tumors (in adults) and other causes should be ruled out by your doctor.
Ruling out malignant diseases is mandatory for adults over 40 years old, even if they have already been diagnosed with hemorrhoids.
- Abdominal pain, chronic diarrhea mixed with blood – same as with weight loss – your doctor should rule out inflammatory bowel diseases, tumors and other more serious conditions.
Important: Hemorrhoids are the most common cause of bleeding when passing stools. However, they are not the only one. It is mandatory to consult with a doctor who will diagnose the cause of bleeding.
Usually it is going to be internal hemorrhoids, which in most cases is not a concern with proper treatment.
This consult is extremely important in adults over 40 years of age or those with alarming symptoms (weight loss, fever, pus, mucus, black stools, etc.). In these cases the symptoms may be caused by more serious conditions – abscesses, fistulas, ulcers, tumors etc.
2How long do bleeding hemorhoids last. Do they bleed a lot
Every case is different so it is impossible to summarize with accuracy. In the early stages the bleeding is minimal (a few drops of blood or trickles on the toilet paper or stool). With proper treatment it often stops after a few days.
In more advanced stages the hemorrhoids are greatly enlarged, prolapse through the anal canal and often become inflamed. There may be bleeding when passing stool for weeks and months, even with a combination of diet, proper hygiene and medications (conservative treatment).
Some thrombosed hemorrhoids (with a clot formed in them, very painful) can „burst“ (rupture) due to increased pressure while the person strains during bowel movement.
This will lead to momentary increased bleeding and often a sensation of pain relief. The bleeding may last for a few minutes, stop and then appear again on subsequent bowel movements. However, bleeding from a „burst“ hemorrhoid might not stop immediately or increase a lot.
Important: In case of heavy or unstoppable bleeding, be sure to seek medical help immediately.
To find out how long the bleeding will last, you must first know why hemorrhoids bleed. It is due to their enlargement and inflammation. Enlarged hemorrhoids have thin and weak walls. Inflammation makes the walls more permeable.
Hemorrhoids mainly enlarge due to increased intra-abdominal pressure – constipation, straining when passing stools or lifting weights (fitness, heavy physical work) and pregnancy.
Sitting for a long time during the day or during defecation causes pooling (stasis) of blood in the pelvis. This leads to further enlargement and bleeding from the hemorrhoids.
Hard and dry stools traumatize and inflame the weakened walls, which also increases the bleeding.
- How long will hemorrhoids bleed depends on:
- Their stage – in the initial stages the hemorrhoids either do not bleed or it’s minimal. For example, a few drops of blood on the toilet paper for several days. They are easily controlled with diet and proper hygiene.
Sometimes there may be bleeding for weeks and months, even with the right conservative treatment. In this case, the prefered treatment may be minimally invasive procedures (rubber band ligation, sclerotherapy etc.) or surgery.
- Their treatment – proper treatment (diet with fiber, mild laxatives, more water) quickly reduces intra-abdominal pressure, which „shrinks“ the hemorrhoids and reduces the bleeding. Soft stools do not traumatize them. Some medications strengthen their walls which further reduces (or stops) the bleeding.
- Do you take blood thinners – they may cause frequent, persistent or significant hemorrhoidal bleeding. Commonly used blood thinners are warfarin, apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto) etc. They don’t actually thin the blood, but stop blood clots from forming or growing larger, which will cause you to bleed easier and for longer.
- Pregnancy – pregnant women often have symptoms of varicose veins and hemorrhoids in the last trimester. Normally the symptoms will disappear or decrease significantly after birth.
3How to treat bleeding hemorrhoids
There are three basic principles that you can apply yourself. You should (1) reduce intra-abdominal pressure, (2) soften hard stools with diet and (3) strengthen/constrict the hemorrhoids.
In the case of 1st, 2nd and some 3rd degree internal hemorrhoids, minimally invasive techniques are effective for stopping the bleeding and prolapse. Some of these techniques are rubber band ligation, sclerotherapy, infrared coagulation.
In the case of 3rd and 4th degree internal hemorrhoids, external hemorrhoids or complications – the most effective treatment is surgery.
- Effective ways to treat bleeding hemorrhoids:
- Diet and proper hygiene – you should eat more fiber (fruits, vegetables, whole-grains, oatmeal) and drink more fluids. They eliminate constipation, which reduces intra-abdominal pressure and „shrinks“ the hemorrhoids. Proper diet and fluid intake also softens the stool, which does not irritate the hemorrhoids.
Never hold your breath when passing stool. Breathe normally. Stay as short as possible on the toilet bowl. Wash immediately with lukewarm water.
Avoid prolonged sitting during the day. If your job requires you to sit, stand up and walk once in a while. You can buy a hemorrhoid cushion to sit on.
- Cold water – after defecation, when you wash, use cold water for 30-60 seconds at the end to constrict the hemorrhoids and reduce bleeding.
- Diosmin – diosmin is a substance that has anti-inflammatory properties and „strengthens“ the venous walls while you take it. It is effective for inflamed and bleeding hemorrhoids and varicose veins.
It is taken in high doses the first couple of days, which are then gradually reduced to maintanance dose. Diosmin might not be available in your country.
- Creams and suppositories – they contain different active substances. Some reduce the inflammation, some constrict the blood vessels and strengthen their walls. Both effects reduce hemorrhoidal bleeding.
- Minimally invasive procedures – they are used for 1st, 2nd and some 3rd degree hemorrhoids if conservative treatment fails (diet, hygiene, medications and creams).
- Surgery – for 3rd and 4th degree internal hemorrhoids, external hemorrhoids or combinations with anal fissures, fistulas etc. They are highly effective, but associated with significant postoperative pain and longer recovery period.