Ask The Doctor: Do I Need Hemorrhoid Surgery
Q.I have bleeding hemorrhoids, and my doctor recommends surgery. How do I know if this is really necessary?
A. The symptoms of itching, rectal pain, and bleeding of hemorrhoids can be very uncomfortable. Yet surgery is rarely the first treatment. Most hemorrhoids can be managed with conservative measures. Try boosting the fiber and fluid in your diet and getting regular exercise to stimulate bowel function. If possible, move your bowels whenever you feel the urge. Use a wet cloth or wipe and pat dry after a bowel movement to avoid irritating inflamed skin. Sit in a warm-water sitz bath to ease discomfort. Over-the-counter hemorrhoid products, including witch-hazel wipes and analgesic creams, can provide temporary relief.
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Procedure For Prolapse And Hemorrhoids
PPH is also called a stapled hemorrhoidectomy. The doctor will use a stapler-like device to reposition the hemorrhoids and cut off their blood supply. Without blood, theyll eventually shrivel and die.
It can treat hemorrhoids that have and have not prolapsed, or slipped down out of the anus.
This procedure moves the hemorrhoid to where there are fewer nerve endings, so it hurts less than a traditional hemorrhoidectomy. Youll also recover faster and have less bleeding and itching. And there are generally fewer complications.
Classification Of Internal Hemorrhoids:
- Grade 1 – A hemorrhoid is present but only visualized by a doctor with ansocopy or colonoscopy. The hemorrhoid does not extend out the anus.
- Grade 2 – The hemorrhoid extends out of the anus with a bowel movement or with straining. After your BM, the hemorrhoid goes back inside on its own.
- Grade 3 – The hemorrhoid extends out of the anus with a bowel movement or with straining. You have to manually push the hemorrhoid back inside the anus. If you have this, you should seek medical attention, but it is not urgent.
- Grade 4 – A hemorrhoid extends outside the anus and are not able to be manually pushed back inside. If you have this seek medical attention immediately. There are significant potential complications.
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Is It Internal Or External Hemorrhoids
If your symptoms include internal itching, anal bleeding anda bulge that comes and goes with bowel movements, an internal hemorrhoid is thelikely culprit.
However, some people are more bothered by externalhemorrhoids, which can cause swelling, itching and bleeding, and be unsightly.Visible bumps and tags are common with external hemorrhoids.
Seek An Experienced Specialist
While you want a specialist who works with the most cutting-edge treatments, you also want someone who has the experience to know what will work based on the details of your specific case. According to the American Board of Surgery, this is not a general practitioner. General practitioners may only see a few cases a year, and general surgeons may only see a few hemorrhoidectomies, fistulotomies, and other similar procedures each year. Without regularly handling these conditions, the rate of misdiagnosis or improper treatment is much higher.
This again highlights the benefits of choosing a specialist, and one who has extensive colorectal surgical experience such as that required to obtain board certification. This experience improves the outcome every step of the way, from routine screenings, to prescribing the right medical treatments, to performing surgery when necessary.
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How To Find A Hemorrhoids Doctor Near Me
There are many ways to find a hemorrhoid doctor in your area. For starters, your primary care physician is a great place to start.
Not only can they treat your hemorrhoids, they can refer you to a specialist if there is a need.
Because some insurance companies require a referral to cover the expenses associated with specialists, you may be required to see your general practitioner first.
Although hemorrhoids are extremely common, most patients dont like to talk about the fact that they have them.
Close family members you are comfortable with may have suggestions for a hemorrhoid doctor.
If you dont feel comfortable talking to a family member about hemorrhoid treatment, there are many online websites that review medical providers.
Search for hemorrhoid doctors near me online. Online review sites like Yelp and Google can show real reviews from patients who have experience working directly with the provider you are looking at.
Do some research on the provider and their medical practice.
You want to find a hemorrhoid doctor that has both the ability to treat your condition effectively and the experience to give you the confidence in your provider.
Common Causes Of Hemorrhoids
Doctors are unable to pinpoint the exact cause of hemorrhoids, but numerous activities and risk factors can increase their presence in North Carolina patients. Common causes of hemorrhoids include:
- Straining during bowel movements
- Increased pressure due to obesity
- Sitting for long periods of time on the toilet
- Eating a low-fiber diet
As we age, hemorrhoids become more common. By age 50, half of older adults experience one or more common symptoms of hemorrhoids. While this condition is not usually dangerous, hemorrhoids can be a significant and painful intrusion in daily life.
December 22, 2017 by inx Medical
If you suffer from hemorrhoids, the good news is that lower grade hemorrhoids can resolve on their own with at-home treatments. But what if they get to the point where you need to see a doctor to treat them? How do you choose where to go and what doctor is right for you?
Heres what you should know about finding the right doctor for you:
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How Hemorrhoids Are Diagnosed By Your Doctor
See your doctor if you think you might have hemorrhoids, especially if you notice bleeding from your anus or rectum, or have bloody stools. Your doctor will want to rule out more serious problems that can cause bleeding from the anus or rectum, such as cancer.
Hemorrhoid symptoms may also be similar to those of other anal and rectal problems, including anal fissures, abscesses, warts, and polyps.
Your doctor will ask about your medical history and will ask you to describe your symptoms. Questions about your eating habits, toilet habits, and enema and laxative use are likely to come up.
Your doctor will also perform a physical exam to look for lumps or swelling, prolapsed internal hemorrhoids, external hemorrhoids, skin irritation, skin tags, and anal fissures, which are small tears in the anus that can result in itching and bleeding. This will involve a visual examination of the area.
Your doctor may also perform a rectal exam to diagnose internal hemorrhoids, check the muscle tone of your anus, and check for blood in the stool. This is done with a gloved, lubricated finger and a tool called an anoscope.
An anoscope is a type of endoscope a hollow, lighted tube that is inserted a few inches into the anus to help the doctor see any problems inside the lining of the rectum. This procedure is performed in the doctors office and doesnt require anesthesia.
Your doctor may also recommend additional tests to rule out other causes of bleeding, especially if you are over age 40.
Drink Plenty Of Water
Dehydration is a potential problem associated with constipation, since fluids or water is needed for fiber to travel smoothly through the digestive system. When you dont get enough water, bowel movements become hard and difficult to pass, and this will enlarge hemorrhoids and increase pelvic pressure.
A study published in the European Journal of Clinical Nutrition in 2003 indicated that fluid loss and fluid restriction can increase constipation, which worsens hemorrhoid symptoms. When considering how to make hemorrhoids go away fast, it is recommended to drink at least one glass of water during each meal or snack daily.
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How Long Do Hemorrhoids Last
How long hemorrhoids last will vary from person to person.
In general, small hemorrhoids can go away on their own in a few days. Larger hemorrhoids, particularly ones that cause a lot of pain, swelling, and itchiness, cant go away on their own and may require treatment from a doctor to heal. Pregnant patients may find that hemorrhoids only go away after they give birth.
Its possible for hemorrhoids to return after theyve been treated. A gastroenterologist can help recommend solutions if you find youre struggling with hemorrhoids that dont go away or keep coming back.
What Can My Doctor Do For Hemorrhoids
There are many ways that hemorrhoids can be handled and treated. These options vary depending on the condition, severity and location of the hemorrhoids. Below are methods that may be employed to treat your hemorrhoids.
Internal hemorrhoids may be injected with a solution that causes a scar to be formed and close off the hemorrhoids. This procedure will only hurt a little but is usually very effective.
2. Cauterization or Coagulation
This method is a painless method of burning off, removing and sealing the end of the hemorrhoids with an electric probe, infrared light or laser beam.
The Coagulation method allows the hemorrhoid to close and shrink and is most effective for treating prolapsed hemorrhoids.
3. Rubber band ligation
In this treatment, the doctor will put a small rubber band around the hemorrhoid to cut off blood supply to the tissues therein.
Rubber band ligations will usually cause the hemorrhoid to dry up, shrink in size and fall due to the unavailability of blood.
4. Surgery or Hemorrhoidectomy
For large internal or external hemorrhoids that keep on worsening and bring excruciating discomfort to the patient, a surgical procedure may be required to remove the hemorrhoids or a newer technique using staples may be applied.
Most of these medical treatments are effective in treating hemorrhoids.
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How Is Rectal Bleeding Diagnosed
When you see a doctor for rectal bleeding, youll be asked a series of questions to help identify the cause. These can include when the rectal bleeding began, any foods you ate prior to the onset of symptoms, if you were constipated, and if you were straining during your bowel movement.
Your doctor will also perform a full medical exam and take your medical history.
Tests that may help determine the cause of rectal bleeding include:
- Colonoscopy, in which a long, flexible tube with a tiny camera on its tip is inserted into the rectum. This allows your doctor to view the inside of the entire colon and look for any abnormalities, notes the Mayo Clinic.
- Sigmoidoscopy, in which a healthcare provider uses a sigmoidoscope, a flexible tube with a light and camera, to view the lower part of your colon and rectum. This test can help diagnose bowel disorders and cancer, per the Mayo Clinic.
- Fecal occult blood test, which is a lab test to detect hidden, or occult, blood in stool. The test can be done in a few different ways, either by the patient collecting stool samples and returning them to their doctor or a lab, or using a flushable pad or tissue that changes color when blood is present, according to the Mayo Clinic.
When To Seek Medical Care For Hemorrhoids
When to call the doctor
- Bleeding from the rectum or anus is never normal and although hemorrhoids are the most common reason to have blood in the stool, it should be discussed with your primary health-care professional. Other causes ofrectal bleeding exist and can be serious. Inflammatory bowel disease and cancers of the colon can present with rectal bleeding. Blood in the stool should never be ignored.
- Medical care should be sought urgently if a person is taking anticoagulation medications such as warfarin , dabigatran , rivaroxiban , apixaban , clopidogrel , prasugrel or enoxaparin .
- Individuals who have associated symptoms such as lightheadedness and weakness may have significant blood loss and may require more urgent care.
- Hemorrhoids do not cause abdominal pain should this pain be present with bleeding, medical care should be sought immediately.
- Prolapsed hemorrhoids that cannot be pushed back through the anus require medical care.
- Thrombosed external hemorrhoids may cause significant pain and medical care may be necessary to remove the clot.
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What To Expect After Hemorrhoid Surgery
Your provider will give you detailed aftercare instructions, including:
- how to clean the surgical site
- a medication schedule and
- pain management techniques .
We may prescribe you stronger pain medication to use for up to five days following your surgery. Youll be scheduled for a four-week follow-up visit with your provider when your surgical site has healed.
Modify Your Daily Activities
- Avoid prolonged sitting or standing. Take frequent short walks.
- If possible, avoid lifting heavy objects frequently. If you must lift heavy objects, always exhale as you lift the object. Don’t hold your breath when you lift.
- If you are pregnant, sleeping on your side will lower pressure on the blood vessels in your pelvis. This can help keep hemorrhoids from becoming bigger.
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Hemorrhoid Treatment At Home
Hemorrhoid symptoms can be quite uncomfortable but there are several treatments you can do at home that may help relieve the pain and discomfort.
Take a warm bath or sitz bath for 10 to 15 minutes after each bowel movement.
Clean around your anal area gently each day with warm water.
Do not use alcohol-based or perfumed cleaning wipes around your anus. These cause drying and irritation.
Moisten toilet tissue before using it to clean after a bowel movement.
Apply cold compresses to your anus.
Use stool softeners.
Take over-the-counter pain relievers, including acetaminophen or nonsteroidal anti-inflammatory drugs , such as ibuprofen or naproxen.
You may help prevent hemorrhoids from forming or from worsening with some lifestyle changes as well. They include:
Dont while moving your bowels.
Limit the amount of time sitting on the toilet.
Increase fiber in your diet. Fiber helps give stool bulk so it can be moved through your intestines, and it also helps water remain in the stool so it doesnt get too dry and difficult to pass.
Increase fluid intake. Drink 6 to 8 glasses of water and other liquids to help keep your stool soft.
Exercise regularly. This will help regulate and stimulate your bowels.
Apply topical ointments. Over-the-counter creams and suppositories can help relieve pain and reduce swelling.
When Exactly Is The Right Time To Do This
It is perfectly okay to head to your hemorrhoid doctor if you experience hemorrhoids irrespective of the extent of the pain and location of the hemorrhoid.
However, due to how common hemorrhoids are, many people will often elect to try some self-medications that are usually effective in controlling and treating the condition.
External hemorrhoids can very painful especially if they become thrombosed .
If your hemorrhoids do not shrink or relief you after a few applications with everyday solutions like Tuck pads or Witch hazel pads, it just might be time to go to see your doctor.
If you experience any type of rectal bleeding, and pass stool that look maroon in color, it is a sign of continued bleeding and a Doctor should be visited in this case also.
If you initially developed an internal hemorrhoid and the lump inside the anus enlarges or becomes more painful it is best to see a doctor.
You should also consult on your hemorrhoids when a tissue from inside the anal canal bulges out. This is called a prolapsed hemorrhoid.
If it does not return or you cannot push it back in manually, you should immediately see a doctor.
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Carolina Digestive Health Associates
Carolina Digestive Health Associates is a group of gastroenterologists serving the residents of North Carolina. We have fourteen highly rated GI doctors who provide service at eight offices and five endoscopy centers. Our doctors work in all major hospitals in the Charlotte metropolitan area.
Our physicians, together with our highly trained physician assistants and nurse practitioners, cover a wide range of specialties and are skilled in diagnosis and treatment. Whether you have chronic problems with your digestive tract, a recent, acute attack or simply want a checkup, our team is here in North Carolina to help you reach your healthcare goals.
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When Should You See A Doctor
Although severe complications from hemorrhoids are extremely rare, it is crucial that you know when to see a doctor for hemorrhoids treatments. Generally speaking, anytime that you feel rectal pain, a lump in your anus, or bleeding, you should visit your doctor in Salt Lake City just to make certain that the cause of your symptoms is not very serious.
In some cases, even less serious circumstances could prompt a consultation with your doctor. For example, if you have been trying to get rid of your hemorrhoids with at-home remedies to no avail, a visit to your physician makes perfect sense. In addition, if you have a history of recurring hemorrhoids and suddenly find that your typical go-to treatments in the past are no longer working, then visit your doctor as soon as possible.
While having bothersome hemorrhoid symptoms could be reason enough for some people to go see their physician, you can use this simple checklist to determine when a visit to your doctor is a must.
- If your hemorrhoids are causing significant discomfort and pain
- If you have any kind of rectal bleeding
- If you are passing stools that look like they have blood
- If you are experiencing a substantial amount of bleeding in your rectum along with faintness or dizziness this could be an emergency for some people
- If your symptoms worsen despite OTC and home remedies
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