Internal hemorrhoids that occur above the dentate line of the anal canal won’t present a lot of symptoms, so they are harder to recognize. If you’re not familiar with the dentate line, this is just an anatomical junction separating the lower 1/3^rd of the anal canal from the upper 2/3rds. The upper portion of the anal canal has no pain receptors so the hemorrhoids that occur in this region are generally pain free. Bleeding may be only symptom or indicator of an internal hemorrhoid. Pain free is the good part of the equation. Unfortunately these internal hemorrhoids may exhibit complications such as becoming prolapsed or strangulated. The prolapsed hemorrhoid is an internal hemorrhoid that becomes so swollen it then gets pushed outside the anal canal. Sometimes these hemorrhoids can be manually inserted back into the canal, sometimes this isn’t possible. There is a grading system in place for hemroids according to the degree of prolapsed. The scale is from Grade I which is a hemorrhoid with no prolapse to a Grade IV which is a hemorrhoid that can’t be manually reinserted.

Most hemorrhoids conditions will never get above a Grade I which is really not that serious, they can usually be managed with diet changes to reduce straining while using the bathroom. However, just because hemorrhoids aren’t usually medically serious doesn’t mean that they don’t cause problems for the people who have them. This is especially true of external hemorrhoids or those occurring below the dentate line. These hemorrhoids can be quite painful and irritating and simple daily activities such as sitting or using the bathroom may become painful.

Even though internal hemorrhoids aren’t painful, this doesn’t mean that if you experience anal bleeding you should ignore it and hope it clears up. It’s important to avoid prolapsed so that hemroid surgery won’t be required. When hemorrhoids begin to prolapsed, the condition then is more serious and may require more than just simple dietary changes. In addition, anal pain and discomfort can also be symptoms of other more serious anal conditions, so it’s important to get a complete examination.