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Hello and thank you for the question.I am Dr. Sohaib, a practicing Internal Medicine Consultant with over 13 years of experience and I will do my best to help you today.Let me review your question for a minute and I will get back to you.
No that's not true that internal hemorrhoids don't cause pain.
They can cause significant pain depending upon their size, and whether if they are infected or not.
Sometimes, it is just an inflammation of the mucosa (covering) of the hemorrhoid secondary to irritation/rubbing of stools, which continues every time you pass stools. In this situation, using laxatives is helpful (fibers/movicol etc.) which makes the stools very soft and allow healing of the inflamed hemorrhoid.
As of now, if despite using fibers and stool softeners, you continue to have pain and intermittent bleed, this is an indication to have a physical exam and anuscopy done, as there may be formation of new hemorrhoids, or there might be increase in size or pre-existing hemorrhoids, or there can be infection also.
Drink plenty of water (1.5 to 2 liters per day); and use stool softeners. Both are necessary to produce regular, soft stools, which reduce straining at defecation and hence promote healing.
Topical ointments that include analgesics, such as mixed hydrocortisone/lidocaine, can also be used for time being to control pain.
Discharge means the chances of infection are more.
Good luck and my sincere wishes for your good health.
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Yes, he can do some basic tests like CBC/CRP and also a clinical exam will tell if you need antibiotics or not.
Get well soon !
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