Internal haemorrhoids on the report

In short

Many coloscopy reports mention internal haemorrhoids almost in passing. Internal haemorrhoids are normal cushions of tissue inside the anal canal that have become enlarged or dilated. They are extremely common and, in most cases, can be managed without surgery. The mention on a report is information; it is rarely an alarm.

What this page covers

What internal haemorrhoids are and how they differ from external ones, the grading system used in many reports, conservative measures that help most people, when an intervention is reasonable, and the symptoms that should still prompt evaluation.

The anatomy — what the cushions are for
Internal versus external — and why the distinction matters
Grades I to IV — what each grade means
Conservative measures: fibre, fluid, time on the toilet, topical treatments
Office-based and surgical options
What to call about

What internal haemorrhoids actually are

Everyone has haemorrhoidal tissue. The anal canal contains three vascular cushions — small areas of dense blood vessels, connective tissue, and smooth muscle — that contribute to fine continence and seal the canal closed at rest. They are part of the normal anatomy. The word haemorrhoids in everyday medical use refers to these cushions when they have become enlarged, congested, or have begun to slip out of place. Internal haemorrhoids sit above the dentate line — the boundary inside the anal canal where two different types of lining meet. The lining above this line is not pain-sensitive in the same way as the skin below it; that is why internal haemorrhoids can bleed without hurting.

External haemorrhoids sit below the dentate line and are covered by skin, with sensation. They can hurt, particularly if they thrombose (clot). External haemorrhoids are not what is usually noted on a coloscopy report; they are evaluated by inspection in the clinic.

The grading system

Reports often grade internal haemorrhoids on a four-point scale. The grade reflects how far the tissue protrudes through the anal canal, not pain or severity in any direct sense.

Grade I — visible inside the canal but does not protrude through it. May bleed.
Grade II — protrudes during straining but reduces (returns inside) on its own.
Grade III — protrudes during straining and needs to be pushed back in.
Grade IV — protrudes and cannot be reduced.

Most haemorrhoids noted incidentally on coloscopy are grade I or II. The grade is one input among several into how aggressively, if at all, to treat them.

What internal haemorrhoids tend to cause

The most common symptom is painless rectal bleeding: bright red blood on the paper, in the bowl, or coating the stool, usually after a hard or strained motion. Itching, a sense of fullness, mucous discharge, and occasional protrusion are also common. Severe pain is unusual with internal haemorrhoids alone, and the presence of severe pain points elsewhere — perhaps to a thrombosed external haemorrhoid, an anal fissure (a small tear in the lining), or another diagnosis worth examination.

Bleeding from haemorrhoids is one of the more common causes of small amounts of bright blood per rectum in adults. It is also the easiest cause of bleeding to attribute incorrectly. A diagnosis of haemorrhoids does not exempt blood from being investigated when the pattern is not typical, when the volume is greater than expected, or when the pattern changes.

Conservative measures that help most people

For most adults, simple and consistent measures resolve or substantially improve symptoms within a few weeks.

Soft, formed stools

Hard stools and straining are the principal mechanical drivers. Adequate dietary fibre — beans, whole grains, fruit, vegetables, ground flaxseed — and adequate fluid produce stools that pass without pushing. A fibre supplement (psyllium, methylcellulose) is reasonable if dietary fibre alone is not enough. Fibre should be increased gradually to avoid bloating, and fluid intake should rise alongside it.

Less time on the toilet

Long sessions sitting and reading or scrolling increase pressure on anal cushions. A few minutes is enough; if a movement is not coming, getting up and trying later usually works better than waiting it out.

Warm sitz baths

Sitting in plain warm water for ten or fifteen minutes once or twice a day, particularly after a movement, relieves discomfort and reduces spasm in the surrounding muscle. No additives are required.

Topical treatments

Over-the-counter creams and suppositories may offer short-term symptom relief. Many contain a mild local anaesthetic, a steroid, or a vasoconstrictor; products with steroids are intended for short use rather than chronic application. A pharmacist or clinician can guide choice. None of them shrinks the cushions in any lasting way; they help the body manage symptoms while the underlying habits change.

Anal hygiene

Gentle cleansing with water (a bidet, a hand-held spray, or a soft cloth) is kinder than vigorous wiping with dry paper. Wet wipes — even those marketed as gentle — can irritate over time; many clinicians recommend against routine use.

When an office-based or surgical option is considered

If symptoms persist despite consistent conservative measures, several options exist. Rubber band ligation, performed in the office, places a small elastic band at the base of an internal haemorrhoid; the tissue sloughs off over the following days. It is the most common procedural treatment for grade I to III internal haemorrhoids. Sclerotherapy (injection of a sclerosing solution) and infrared coagulation are alternatives, used in some practices. Surgical haemorrhoidectomy is reserved for grade IV haemorrhoids, for refractory cases, or when there is significant external disease alongside.

None of this is the path most people take. The majority of internal haemorrhoids noted on a coloscopy are managed entirely with the steps above and never require a procedure.

Symptoms that still warrant evaluation

An incidental note of haemorrhoids does not mean any future bleeding can be attributed to them. The same person can have haemorrhoids and another source of bleeding. Worth a call to your clinician: a meaningful change in the pattern of bleeding (darker blood, mixed with stool, or larger volume), a new change in bowel habit, unexplained iron deficiency, persistent perianal pain, a lump that does not reduce, or any signs of infection. The presence of haemorrhoids on the report is not a reason to delay evaluation of new or different symptoms.

What to ask your clinician

What grade of internal haemorrhoids were noted, and is that consistent with what I have been experiencing?
Are there any other findings around the anal canal — fissures, skin tags, external haemorrhoids — worth knowing about?
Which conservative measures should I try first, and for how long before reconsidering?
Is there a topical preparation you would recommend or avoid for me?
How will I know if bleeding is from haemorrhoids versus something I should report?
If conservative measures do not help, what office-based options do you offer?
Should anything I take — including blood thinners or NSAIDs — be reconsidered with this finding in mind?

Common worries, briefly addressed

Is bleeding from haemorrhoids dangerous?

Small amounts of bright red bleeding around bowel movements is common and not usually a medical emergency. Heavy bleeding, persistent bleeding, dizziness, or signs of low blood count are different and worth prompt evaluation. If you have known haemorrhoids and the pattern changes — colour, volume, or timing — that is worth a call rather than an assumption.

Will heavy lifting make haemorrhoids worse?

Repeated breath-holding strain raises pressure in the anal cushions and can aggravate symptoms. Weight training with proper breathing is generally fine; sustained Valsalva-style straining is the part to reconsider.

Are haemorrhoids caused by sitting too much?

Long bouts of sitting on the toilet — not sitting in general — are the consistent driver. Long sitting at a desk has not been clearly shown to cause haemorrhoids, though it is correlated with constipation, which is a contributor.

Should I worry about haemorrhoids during pregnancy?

They are very common in pregnancy and the postpartum period because of pressure from the uterus and changes in stool habits. Most resolve over the months following birth. See your obstetric clinician about which treatments are appropriate.

The report says "non-bleeding internal haemorrhoids." What does that mean?

That the endoscopist saw cushions consistent with internal haemorrhoids but no active bleeding from them at the time of the test. It is a description, not a verdict on past or future symptoms.

Sources

American Society of Colon and Rectal Surgeons — clinical practice guidelines for the management of haemorrhoids
American College of Gastroenterology — clinical guideline on benign anorectal disorders
European Society of Coloproctology — guideline on haemorrhoidal disease
National Institute for Health and Care Excellence — guidance on haemorrhoids
British Society of Gastroenterology — guidance on lower gastrointestinal bleeding
American Gastroenterological Association — clinical practice updates on benign anorectal conditions