Internal bleeding hemorrhoids are normally small, swollen veins that are in the wall of the anal canal. Of course, that said, they can also be fairly large, sagging, bulging veins that are there all the time. If they bulge out and are then squeezed by the muscles in the anus, it can be a painful experience. If the blood supply to the hemorrhoids is cut off, it can become even more painful.

With internal hemorrhoids bleeding may cause blood as well as mucus on the toilet paper and on the stool after bowel movements. The small internal hemorrhoids may not grow and may not bulge if pressure on the bowels is minimized.

When internal bleeding hemorrhoids are large, they may bulge from the anus and after bowel movements it may be necessary to gently push them back in. Sometimes they remain outside the anus, and in some rarer cases, internal hemorrhoids may bugle out and then swell.

As previously mentioned, the muscles that control the opening of the anus, and it’s closing,  may cut off the blood supply to bulging, swollen hemorrhoids. This is called a strangulated hemorrhoid and the hemorrhoid tissue may die. This is a painful occurrence and may cause pus and blood at the anus and will need immediate medical attention and emergency surgery to prevent death of the tissue and subsequent dangerous infection.

The above is an emergency situation and a rare one.
Bleeding internal hemorrhoids treatment may sometimes call for surgery but only as a last resort.

Please be sure to check with your physician to verify the source of bleeding from the rectum as while it is a symptom of bleeding internal hemorrhoids, it may also be a symptom of a much more serious condition.